You can search for reports, forms, policies and pamphlet and posters with information about specific programs and services.
Download | Number | Name | Effective Date |
---|---|---|---|
|
FAA-1725A-S | Verificación de Otros Ingresos | 05/01/2023 |
|
FAA-0255A-S | Afirmación De Hogares Por Separado | 05/01/2023 |
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FAA-1004A-SLP | Designation of EBT Alternate Card Holder - Large Print (Spanish) | 05/01/2023 |
|
CCA-0221A-S | Declaración de Servicios del Proveedor de Cuidado en Casa de Familia | 05/01/2023 |
|
FAA-0065A | Verification of Living Arrangements/Residential Address (English) | 05/01/2023 |
|
FAA-1765A-S | Autoridad para Divulgar Información | 05/01/2023 |
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FAA-0255A | Separate Household Status Statement | 05/01/2023 |
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FAA-1004A-SXLP | Designation of EBT Alternate Card Holder - Extra Large Print (Spanish) | 05/01/2023 |
|
FAA-0065A-XLP | Verification of Living Arrangements/Residential Address - Extra Large Print (English) | 05/01/2023 |
|
FAA-1701A | Verification of Terminated Employment (English) | 05/01/2023 |
Download | Number | Name | Effective Date |
---|---|---|---|
|
DDD-1984A | Behavior Plan / Packet Requirements (English) | 11/01/2021 |
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CCA-0044A | Verification of Shelter Case Plan (English) | 11/01/2021 |
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DDD-1984A-S | Behavior Plan / Packet Requirements (Spanish) | 11/01/2021 |
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CCA-0024A | Employment and Wage Verification Statement (English) | 11/01/2021 |
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CCA-0024A-S | Employment and Wage Verification Statement (Spanish) | 11/01/2021 |
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SNA-1066A | Voluntary Participation Agreement | 10/01/2021 |
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DDD-1661A | DDD Tribal Health Program (THP) Equipment and Supplies Prior Authorization | 10/01/2021 |
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CSE-1129A | Electronic Payment Authorization (English) | 09/01/2021 |
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DDD-2099A | Electronic Visit Verification (EVV) Member Contingency/ Back-Up Plan | 09/01/2021 |
|
CSE-1281A | Agreement to Accept Service by Mail Paternity or Establishment (English/Spanish) | 09/01/2021 |
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