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Download Number Form Name Effective Date
DES-1031AS Constancia de Recibo de Quejas de Violación a la Privacidad Bajo la HIPAA (Ley de Privacidad y Portabilidad de Seguro Médico, por sus siglas en inglés) 02/01/2011
DES-1034AS Planilla de Seguimiento Sobre Divulgación de Información de Contabilidad 02/01/2011
AAA-1084A SCSEP Assessment Guide 02/01/2011
DES-1032AS Repuesta a Queja de Violación a la Privacidad Bajo la HIPAA (Ley de Privacidad y Portabilidad de Seguro Médico, por sus siglas en inglés) 02/01/2011
DES-1038A Request for Amended/Correction of Protected Health Information 01/01/2011
AAA-1100A-S SCSEP Participant Handbook (Spanish) 01/01/2011
DES-1034A Accounting Disclosure Tracking 01/01/2011
DES-1035A Request for an Accounting of Disclosures of Protected Health Information 01/01/2011
DES-1036A Accounting of Disclosures of Protected Health Information 01/01/2011
DES-1039A Request for Restriction of Protected Health Information 01/01/2011

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Download Number Form Name Effective Date
HRP-1041A Commodity Senior Food Program (CSFP) Waiting List Enrollment Notification 08/01/2017
HRP-1042A Commodity Senior Food Program (CSFP) Waiting List Notification 08/01/2017
PAD-529 Human Rights Brochure 08/01/2017
UB-106-T-I Completion Instructions for Approved Training Continued Claim, UB-106-T 08/01/2017
PAD-529-S Comisiones de Derechos Humanos 08/01/2017
LDU-1003A Labor Dispute Information 08/01/2017
CC-031-FF Verbal Notice of Eligibility (Eng/Span) 08/01/2017
LDU-1003AS Labor Dispute Information (Spanish) 08/01/2017
HRP-1030A Commodity Senior Food Program (CSFP) Civil Rights Complaint / Grievance 08/01/2017
HRP-1032A Commodity Senior Food Program (CSFP) Informal Dispute Resolution Meeting / Fair Hearing Request 08/01/2017

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