You can search for reports, forms, policies and pamphlet and posters with information about specific programs and services.
Download | Number | Name | Effective Date |
---|---|---|---|
|
FAA-1004A-S | Designation of EBT Alternate Card Holder (Spanish) | 05/01/2023 |
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FAA-0574A-XLP | Withdrawal or Stop Benefits/Appeal Request (Large Extra Print) | 05/01/2023 |
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FAA-1494A-LP | Authorized Representative Removal (Large Print) | 05/01/2023 |
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FAA-1768A-S | Formulario de Solicitud de Reducción de Pago en Exceso | 05/01/2023 |
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AAA-1296A | Protect Yourself and Medicare | 05/01/2023 |
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FAA-1799A | Drug/Alcohol Treatment Center Training Acknowledgment | 05/01/2023 |
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FAA-0065A-XLP | Verification of Living Arrangements/Residential Address - Extra Large Print (English) | 05/01/2023 |
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FAA-1506A-S | Statement of No Income (Spanish) | 05/01/2023 |
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FAA-1765A | Authority to Release Information | 05/01/2023 |
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FAA-0574A-SXLP | Retirar o Suspender Beneficios/Solicitud de Apelación (Letra Extra Grande) | 05/01/2023 |
Download | Number | Name | Effective Date |
---|---|---|---|
|
CSE-0258A | Affidavit of Paternity Rescission (English/Spanish) | 12/01/2020 |
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DDD-2036A | Member Funds Monthly Ledger (English) | 12/01/2020 |
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CCA-0201A | Certification Statement for Providing Child Care Services | 12/01/2020 |
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CCA-0201A-S | Declaración de Certificación para Proveer Servicios de Cuidado de Niños | 12/01/2020 |
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DDD-2063A | Ongoing Quarterly Progress Report (QPR) Plan of Care/Treatment Plan | 12/01/2020 |
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CCA-1277A | Sample Child Care Provider Expulsion Prevention Policy (English) | 11/01/2020 |
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CCA-1277A-S | Sample Child Care Provider Expulsion Prevention Policy (Spanish) | 11/01/2020 |
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LCR-1063A-S | Petición Audiencia Sobre Denegación, Revocación o Suspensión de Certificación de Hogar de o Comunitario | 10/01/2020 |
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LCR-1030A | Request to Withdraw HCBS Certification | 10/01/2020 |
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LCR-1063A | Developmental Home License Denial, Revocation or Suspension Hearing Request | 10/01/2020 |
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