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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CCA-0221A-S | Declaración de Servicios del Proveedor de Cuidado en Casa de Familia | 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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FAA-1506A-S | Statement of No Income (Spanish) | 05/01/2023 |
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FAA-1004A-S | Designation of EBT Alternate Card Holder (Spanish) | 05/01/2023 |
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FAA-0065A-SXLP | Verification of Living Arrangements/Residential Address - Extra Large Print (Spanish) | 05/01/2023 |
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FAA-0051A | Verification of Financial Accounts (English) | 05/01/2023 |
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FAA-1249A-LP | Verification of Disability (Large Print) | 05/01/2023 |
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FAA-0559A | Food Distribution / Nutrition Assistance Program Participation | 05/01/2023 |
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FAA-1565A-S | Acuerdo de Prueba de Drogas para recibir Asistencia Nutricional | 05/01/2023 |
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FAA-0053A | Verification of New/Current Employment (English) | 05/01/2023 |
Download | Number | Name | Effective Date |
---|---|---|---|
|
CCA-1235A | CCA Change Report | 11/01/2021 |
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CCA-1186A | Authority to Release Information | 11/01/2021 |
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CCA-1235A-S | CCA Informe de Cambios | 11/01/2021 |
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DDD-1984A | Behavior Plan / Packet Requirements (English) | 11/01/2021 |
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DDD-1984A-S | Behavior Plan / Packet Requirements (Spanish) | 11/01/2021 |
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DDD-1661A | DDD Tribal Health Program (THP) Equipment and Supplies Prior Authorization | 10/01/2021 |
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SNA-1066A | Voluntary Participation Agreement | 10/01/2021 |
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LCR-1079A | Developmental Home Compliance Review | 09/01/2021 |
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DDD-2099A | Electronic Visit Verification (EVV) Member Contingency/ Back-Up Plan | 09/01/2021 |
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DDD-2099A-S | Plan de contingencia/respaldo del miembro para la verificación de visita electrónica (EVV) | 09/01/2021 |
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