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-0053A-XLP | Verification of New/Current Employment - Extra Large Print (English) | 05/01/2023 |
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FAA-1249A | Verification of Disability | 05/01/2023 |
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FAA-0620A | Treatment Center Change Report | 05/01/2023 |
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FAA-1004A-XLP | Designation of EBT Alternate Card Holder - Extra Large Print (English) | 05/01/2023 |
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GCI-1033A-S | Resumen de la Conferencia de Transición | 05/01/2023 |
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GCI-1037A | Public Education Agency (PEA) Notification/Referral | 05/01/2023 |
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FAA-0098C | EBT Transaction Adjustment Hearing Request | 05/01/2023 |
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FAA-0412A-XLP | Change Report - Extra Large Print (English) | 05/01/2023 |
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FAA-1353A | Affidavit Attesting Citizenship for Cash Assistance and Nutrition Assistance | 05/01/2023 |
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FAA-0574A-LP | Withdrawal or Stop Benefits/Appeal Request (Large Print) | 05/01/2023 |
Download | Number | Name | Effective Date |
---|---|---|---|
|
DDD-2090A | Program Integrity Requirements Verification | 03/01/2021 |
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DDD-2093A | DDD Behavioral Health Advocate Referral | 03/01/2021 |
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DDD-2092A | DDD Behavioral Health Advocacy Plan | 03/01/2021 |
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DDD-2092A-S | Plan de Defensa de la Salud Conductual de la DDD | 03/01/2021 |
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UB-010 | Eligibility Review Questionnaire (English) | 02/01/2021 |
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UB-010-S | Eligibility Review Questionnaire (Spanish) | 02/01/2021 |
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DDD-2087A | Documentation Guidelines: Occupational, Physical, and Speech-Language Pathology Therapy Services | 02/01/2021 |
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RSA-1298A | Referral Form (English) | 02/01/2021 |
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FAA-1796A | Affidavit of Visually Viewed Documentation | 02/01/2021 |
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RSA-1396A | Secure Email Waiver | 02/01/2021 |
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