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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UB-099-Y | Certification of Understanding (English / Spanish) | 07/01/2019 |
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LCR-1007A | Home Visit Report Supplement to Notice of Inspection and Due Process Rights | 07/01/2019 |
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CCA-1260A-S | Solicitud de Proveedor Suplente | 07/01/2019 |
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LCR-1007A-S | Informe de Visita al Hogar Suplemento Al Aviso de Derechos De Inspección y Debido Proceso | 07/01/2019 |
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Statistical Bulletin June 2019 | Statistical Bulletin June 2019 | 07/15/2019 |
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30th Month Mar 2019 | 30th Month Financial Report FY 2019 through Mar 2019 | 07/26/2019 |
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30th Month Apr 2019 | 30th Month Financial Report FY 2019 through Apr 2019 | 07/26/2019 |
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30th Month May 2019 | 30th Month Financial Report FY 2019 through May 2019 | 07/26/2019 |
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DDD-0524A-S | Authorization for Release of Information (Spanish) | 08/01/2019 |
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POU-003 | Notice to Employees (English) | 08/01/2019 |
Download | Number | Name | Effective Date |
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DDD-2173A | Request for Amended/Correction of Protected Health Information (PHI) | 02/01/2023 |
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DDD-1658A-S | Agency With Choice: Individual Representative (Spanish) | 02/01/2023 |
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DDD-2171A | Accounting Disclosures Tracking | 02/01/2023 |
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LCR-1084A | Application for Renewal or Amended HCBS Certificate for Independent Providers | 02/01/2023 |
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DDD-2174A | Request for Restriction of Protected Health Information (PHI) | 02/01/2023 |
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LCR-1084A-S | Solicitud de Renovación o Certificado de HCBS Modificado para Proveedores Independientes | 02/01/2023 |
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DDD-2172A | Authorization of Disclosure of Confidential Substance Use Disorder (SUD) Record Information | 02/01/2023 |
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WIO-1108A | WIOA EO Monitoring Review Guide (English) | 02/01/2023 |
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FAA-0001U | Notice of Non-Discrimination/Aviso De No Discriminación AH-1000 | 02/01/2023 |
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DDD-1580A | Reversal Adjustment Request Cover Sheet (English) | 02/01/2023 |
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