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-0574A-LP | Withdrawal or Stop Benefits/Appeal Request (Large Print) | 05/01/2023 |
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GCI-1041A-S | Consentimiento para el Uso del Seguro de Salud | 05/01/2023 |
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FAA-0257A | Individual Development Account Agreement | 05/01/2023 |
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FAA-0412A-LP | Change Report - Large Print (English) | 05/01/2023 |
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FAA-0053A | Verification of New/Current Employment (English) | 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-1725A | Verification of Other Income | 05/01/2023 |
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FAA-0559A | Food Distribution / Nutrition Assistance Program Participation | 05/01/2023 |
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FAA-1768A | Overpayment Compromise Request Form | 05/01/2023 |
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DDD-1345A | Medical Justification for Home Modifications (English) | 05/01/2023 |
Download | Number | Name | Effective Date |
---|---|---|---|
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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-2099A | Electronic Visit Verification (EVV) Member Contingency/ Back-Up Plan | 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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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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DDD-2100A | DDD Electronic Visit Verification Paper Timesheet | 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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