You can search for reports, forms, policies and pamphlet and posters with information about specific programs and services.
Download | Number | Name | Effective Date |
---|---|---|---|
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FAA-0255A | Separate Household Status Statement | 05/01/2023 |
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CCA-1163A-S | Afidávit de Exención de Vacunación - Para Miembros del Hogar de 13 años de edad y Menores | 05/01/2023 |
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FAA-1533A | Verification of Unfitness for Work for Adults | 05/01/2023 |
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FAA-1494A-XLP | Authorized Representative Removal (Extra Large Print) | 05/01/2023 |
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FAA-1701A | Verification of Terminated Employment (English) | 05/01/2023 |
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FAA-0053A-LP | Verification of New/Current Employment - Large Print (English) | 05/01/2023 |
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AAA-1296A | Protect Yourself and Medicare | 05/01/2023 |
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CCA-1164A | Affidavit of Immunization Exemption - For Children in Care (English) | 05/01/2023 |
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FAA-0412A-SXLP | Change Report - Extra Large Print (Spanish) | 05/01/2023 |
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FAA-1353A-S | Afidávit que Certifica la Ciudadanía para recibir Asistencia en Efectivo y Asistencia Nutricional | 05/01/2023 |
Download | Number | Name | Effective Date |
---|---|---|---|
|
CSE-1281A | Agreement to Accept Service by Mail Paternity or Establishment (English/Spanish) | 09/01/2021 |
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DDD-2099A | Electronic Visit Verification (EVV) Member Contingency/ Back-Up Plan | 09/01/2021 |
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DDD-2099A-S | Plan de contingencia/respaldo del miembro para la verificación de visita electrónica (EVV) | 09/01/2021 |
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DDD-2100A-S | Hoja de horas de verificación de visita electrónica de DDD | 09/01/2021 |
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CSE-1129A | Electronic Payment Authorization (English) | 09/01/2021 |
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DDD-2100A | DDD Electronic Visit Verification Paper Timesheet | 09/01/2021 |
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CSE-1129A-S | Electronic Payment Authorization (Spanish) | 09/01/2021 |
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DDD-2101A-S | Electronic Visit Verification (EVV) Paper Timesheet Attestation (Spanish) | 09/01/2021 |
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DDD-2102A | Electronic Visit Verification (EVV) Designee Attestation (English) | 09/01/2021 |
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LCR-1079A | Developmental Home Compliance Review | 09/01/2021 |
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