You can search for reports, forms, policies and pamphlet and posters with information about specific programs and services.
Number | Document Name | Effective Date |
---|---|---|
DDD-1345A | Medical Justification for Home Modifications (English) | 05/01/2023 |
CCA-1170A | Withdrawal or Termination Request for Child Care Providers | 05/01/2023 |
FAA-1004A | Designation of EBT Alternate Card Holder (English) | 05/01/2023 |
GCI-1041A-S | Consentimiento para el Uso del Seguro de Salud | 05/01/2023 |
FAA-0065A-SXLP | Verification of Living Arrangements/Residential Address - Extra Large Print (Spanish) | 05/01/2023 |
GCI-1037A-S | Aviso o Recomendación de la Agencia de Educación Pública (PEA) | 05/01/2023 |
FAA-0574A-LP | Withdrawal or Stop Benefits/Appeal Request (Large Print) | 05/01/2023 |
FAA-1565A-S | Acuerdo de Prueba de Drogas para recibir Asistencia Nutricional | 05/01/2023 |
CCA-1170AS | Petición para el Retiro o Terminación de Solicitud - Para Proveedores de Cuidado de Niños | 05/01/2023 |
FAA-0574A-SLP | Retirar o Suspender Beneficios/Solicitud de Apelación (Letra Grande) | 05/01/2023 |
Number | Document Name | Effective Date |
---|---|---|
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 |
ESA-1338A | Language Line Translation Services Utilized | 03/01/2021 |
DDD-1530A-SLP | Managed Risk Agreement Services and/or Placement -Large Print (Spanish) | 03/01/2021 |
DDD-2090A | Program Integrity Requirements Verification | 03/01/2021 |
RSA-1298A | Referral Form (English) | 02/01/2021 |
RSA-1298A-S | Referral Form (Spanish) | 02/01/2021 |
RSA-1298A-LP | Referral Form - Large Print (English) | 02/01/2021 |
RSA-1298A-S-LP | Referral Form - Large Print (Spanish) | 02/01/2021 |
UB-010 | Eligibility Review Questionnaire (English) | 02/01/2021 |
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