You can search for reports, forms, policies and pamphlet and posters with information about specific programs and services.
Number | Document Name | Effective Date |
---|---|---|
FAA-0574A-LP | Withdrawal or Stop Benefits/Appeal Request (Large Print) | 05/01/2023 |
GCI-1041A-S | Consentimiento para el Uso del Seguro de Salud | 05/01/2023 |
FAA-0098C-S | Solicitud de Audiencia por Ajuste de Transacción EBT | 05/01/2023 |
FAA-0065A-SXLP | Verification of Living Arrangements/Residential Address - Extra Large Print (Spanish) | 05/01/2023 |
CCA-1163A-S | Affidavit of Immunization Exemption - For Household Members Age 13 and Younger (Spanish) | 05/01/2023 |
FAA-1725A | Verification of Other Income | 05/01/2023 |
FAA-0259A | Unwed Minor Parent Abuse/Neglect Claim | 05/01/2023 |
FAA-0574A-SLP | Retirar o Suspender Beneficios/Solicitud de Apelación (Letra Grande) | 05/01/2023 |
FAA-1004A-XLP | Designation of EBT Alternate Card Holder - Extra Large Print (English) | 05/01/2023 |
FAA-1546A | Sponsor Deeming Information (English) | 05/01/2023 |
Number | Document Name | Effective Date |
---|---|---|
DDD-2090A | Program Integrity Requirements Verification | 03/01/2021 |
DDD-2093A | DDD Behavioral Health Advocate Referral | 03/01/2021 |
DDD-2092A | DDD Behavioral Health Advocacy Plan | 03/01/2021 |
DDD-2092A-S | Plan de Defensa de la Salud Conductual de la DDD | 03/01/2021 |
UB-010 | Eligibility Review Questionnaire (English) | 02/01/2021 |
UB-010-S | Eligibility Review Questionnaire (Spanish) | 02/01/2021 |
DDD-2087A | Documentation Guidelines: Occupational, Physical, and Speech-Language Pathology Therapy Services | 02/01/2021 |
FAA-1796A | Affidavit of Visually Viewed Documentation | 02/01/2021 |
RSA-1298A | Referral Form (English) | 02/01/2021 |
RSA-1298A-S | Referral Form (Spanish) | 02/01/2021 |
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