You can search for reports, forms, policies and pamphlet and posters with information about specific programs and services.
Number | Document Name | Effective Date |
---|---|---|
FAA-0574A-XLP | Withdrawal or Stop Benefits/Appeal Request (Large Extra Print) | 05/01/2023 |
FAA-1768A | Overpayment Compromise Request Form | 05/01/2023 |
FAA-0574A-LP | Withdrawal or Stop Benefits/Appeal Request (Large Print) | 05/01/2023 |
GCI-1041A | Consent to Bill Health Insurance | 05/01/2023 |
GCI-1033A-S | Resumen de la Conferencia de Transición | 05/01/2023 |
CCA-1170AS | Petición para el Retiro o Terminación de Solicitud - Para Proveedores de Cuidado de Niños | 05/01/2023 |
FAA-0574A-SXLP | Retirar o Suspender Beneficios/Solicitud de Apelación (Letra Extra Grande) | 05/01/2023 |
FAA-1494A | Authorized Representative Removal | 05/01/2023 |
FAA-1768A-S | Formulario de Solicitud de Reducción de Pago en Exceso | 05/01/2023 |
FAA-0574A | Withdrawal or Stop Benefits/Appeal Request | 05/01/2023 |
Number | Document Name | Effective Date |
---|---|---|
DDD-1530A-SLP | Managed Risk Agreement Services and/or Placement -Large Print (Spanish) | 03/01/2021 |
DDD-2090A | Program Integrity Requirements Verification | 03/01/2021 |
DDD-2093A | DDD Behavioral Health Advocate Referral | 03/01/2021 |
DDD-2092A | DDD Behavioral Health Advocacy Plan | 03/01/2021 |
DDD-2092A-S | Plan de Defensa de la Salud Conductual de la DDD | 03/01/2021 |
UB-010 | Eligibility Review Questionnaire (English) | 02/01/2021 |
UB-010-S | Eligibility Review Questionnaire (Spanish) | 02/01/2021 |
LCR-1087A | Child Developmental Certified Home Application Cover Page | 02/01/2021 |
RSA-1298A | Referral Form (English) | 02/01/2021 |
RSA-1298A-S | Referral Form (Spanish) | 02/01/2021 |
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