RRSSC Request Form

The RRSSC is only for staffing requests directly related to an active COVID-19 outbreak in which staff shortages are impacting resident care. Requests are limited to short term assistance and are not intended to be a long-term staffing solution.

State funded staffing resources are:

  • Limited in capacity
  • Available for facilities experiencing staff shortages as a direct result of COVID-19
  • Funds are temporarily intended to bridge the gap while facilities stabilize their workforce

Facilities must continue to actively recruit and retain full time staff in order to receive the temporary funding support.

Please complete this form to request assistance from the RRSSC. Your request will be reviewed, and you will be contacted directly for follow-up.



Type of Facility(Required)
Facility Designation(Required)



Is your facility in an active COVID outbreak or have a staff member out with COVID-19?(Required)

How many staff are currently out as a result of COVID-19?

When are these staff expected to return to work? Please note the date the first staff member returns and the date the last staff member is expected to return.



Are you currently utilizing crisis staffing to provide resident care?
Have you requested staffing support through this program before?

Attestation Statements

  1. I verify that the requested staff will be used to address a short-term, COVID-19 outbreak-related staff shortage.
  2. I verify that the facility is actively recruiting for permanent staff.
  3. I verify that the facility will not separately bill to, or be reimbursed by, an insurance provider for staffing services provided by the RRSSC.
This field is for validation purposes and should be left unchanged.