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New Requirement: Online Submission of Housing with Services Establishments and Alzheimer’s and Dementia SCU State Forms

Posted May 16, 20192 min Read

Payment & Reimbursement

Disclosure for Housing with Services Establishments (State Form 49028) Submission

Last fall, the FSSA Division of Aging transitioned submission of the Disclosure for Housing with Services Establishments State Form 49028 and the Alzheimer’s and Dementia Special Care Unit State Form 48896 to a new web-based system at, replacing the current method of a paper mailed submission.

Even if you have already filed this form late last year or early this year VIA PAPER, you must resubmit online.

Existing facilities should have received an email from with the subject “INconnect Alliance Facility Invitation” with the link to set up an account to access your facility. If you did not, please contact the Division of Aging at (317) 232-7020 or  Brand new facilities should go to Housing with Services, select “Log In,” and then create a new account to get started.

Once your form is submitted and approved by the state, you will receive email reminders from when it is time for the annual renewal. You are able to save, print, or update your form at any time by logging into Housing with Services.

Please note that per Indiana Code 12-10-15, State Form 49028 must be filed annually within 4 months after the end of the facility’s fiscal year. Due to the timing of the roll-out of the new system, many facilities that submitted their forms late last fall or early 2019 will expire this month if not renewed.  If your fiscal year begins in January and/or you have received a renewal notification, please log into your account to renew your form prior to the end of the month.  Forms needing to be renewed will appear on your “Upcoming Renewals” dashboard.  Once a form expires, it can no longer be updated and will need to be fully resubmitted.

Thank you for your attention to this matter.  If you have any questions, please contact the Division of Aging at (317) 232-7020 or email