You can search for reports, forms, policies and pamphlet and posters with information about specific programs and services.
Download | Number | Name | Effective Date |
---|---|---|---|
|
GCI-1041A | Consent to Bill Health Insurance | 05/01/2023 |
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FAA-0065A-S | Verification of Living Arrangements/Residential Address (Spanish) | 05/01/2023 |
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FAA-1004A | Designation of EBT Alternate Card Holder (English) | 05/01/2023 |
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FAA-0574A-SXLP | Retirar o Suspender Beneficios/Solicitud de Apelación (Letra Extra Grande) | 05/01/2023 |
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FAA-1768A | Overpayment Compromise Request Form | 05/01/2023 |
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FAA-1725A-S | Verificación de Otros Ingresos | 05/01/2023 |
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FAA-1494A-SXLP | Remoción de un(a) Representante Autorizado(a) (Letra Extra Grande) | 05/01/2023 |
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FAA-0065A-SLP | Verification of Living Arrangements/Residential Address - Large Print (Spanish) | 05/01/2023 |
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FAA-1366A | Eligibility Requirements | 05/01/2023 |
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FAA-1494A | Authorized Representative Removal | 05/01/2023 |
Download | Number | Name | Effective Date |
---|---|---|---|
|
DDD-1661A | DDD Tribal Health Program (THP) Equipment and Supplies Prior Authorization | 10/01/2021 |
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SNA-1066A | Voluntary Participation Agreement | 10/01/2021 |
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DDD-2102A | Electronic Visit Verification (EVV) Designee Attestation (English) | 09/01/2021 |
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DDD-2102A-S | Electronic Visit Verification (EVV) Designee Attestation (Spanish) | 09/01/2021 |
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CSE-1168A | Agreement to Accept Service by Mail - TANF Workshops | 09/01/2021 |
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DDD-2098A | Hourly Nursing Assessment Tool (H-NAT) | 09/01/2021 |
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CSE-1281A | Agreement to Accept Service by Mail Paternity or Establishment (English/Spanish) | 09/01/2021 |
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CSE-1129A | Electronic Payment Authorization (English) | 09/01/2021 |
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CSE-1129A-S | Electronic Payment Authorization (Spanish) | 09/01/2021 |
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LCR-1079A | Developmental Home Compliance Review | 09/01/2021 |
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