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Download Number Form Name Effective Date
FAA-1701A Verification of Terminated Employment 08/01/2019
FAA-1701A-LP Verification of Terminated Employment (Large Print) 08/01/2019
FAA-1701A-XLP Verification of Terminated Employment (Extra Large Print) 08/01/2019
FAA-1724A Application Signature Pages 11/01/2019
FAA-1725A Verification of Other Income 06/01/2019
FBU-1003A DERS Direct Service Position 05/01/2017
FCT-1000A Formal Request for Tribal Consultation 02/01/2015
FCT-1001A Acknowledgment of Tribal Consultation Request 12/01/2016
FNS-252-2 Application for Meal Services 10/01/2017
GCI-1020A Authorization to Disclose Protected Health Information 08/01/2011

Download Number Form Name Effective Date
TANF State Plan Summary TANF State Plan Effective October 1, 2011 Summary 10/01/2011
TANF-WVP 2018 Temporary Assistance for Needy Families (TANF) Work Verification Plan 2018 01/01/2018
Title XIX Reimbursement Rates Study Report 2014 Annual Title XIX Reimbursement Rates Study Report 2014 10/01/2014
Tribal Consultation Report 2006 Tribal Consultation Report 2006 12/31/2006
Tribal Consultation Report 2008 Tribal Consultation Report 2008 06/27/2008
Tribal Consultation Report 2009 Tribal Consultation Report 2009 06/30/2009
Tribal Consultation Report 2010 Tribal Consultation Report 2010 07/07/2010
Tribal Consultation Report 2011 Tribal Consultation Report 2011 06/30/2011
Tribal Consultation Report 2012 Tribal Consultation Report 2012 09/17/2012
Tribal Consultation Report 2013 Tribal Consultation Report 2013 09/04/2013

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