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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FAA-1493A-SXLP | Authorized Representative Request - Extra Large Print (Spanish) | 06/01/2023 |
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FAA-1821A-LP | Elderly Simplified Application Project (ESAP) Nutrition Assistance Application - Large Print (English) | 06/01/2023 |
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FAA-1439A | Self-Employment Income Statement (English) | 06/01/2023 |
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DDD-1713A-S | DDD Customer Service Center (Spanish) | 06/01/2023 |
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FAA-1821A-SLP | Elderly Simplified Application Project (ESAP) Nutrition Assistance Application - Large Print (Spanish) | 06/01/2023 |
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FAA-0177A | Claim of Good Cause (Eng/Span) | 06/01/2023 |
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DDD-1479A-S | Notice of Extension (Spanish) | 06/01/2023 |
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FAA-1821A-XLP | Elderly Simplified Application Project (ESAP) Nutrition Assistance Application - Extra Large Print (English) | 06/01/2023 |
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WIO-1075A | Transfer of Funds Request Form (English) | 06/01/2023 |
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GCI-1161A-3 | Service Coordination Services Programmatic Meeting June 2023 | 06/01/2023 |
Download | Number | Name | Effective Date |
---|---|---|---|
|
SNA-1066A | Voluntary Participation Agreement (English) | 10/01/2021 |
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DDD-1661A | DDD Tribal Health Program (THP) Equipment and Supplies Prior Authorization | 10/01/2021 |
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DDD-2102A-S | Electronic Visit Verification (EVV) Designee Attestation (Spanish) | 09/01/2021 |
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CSE-1168A | Agreement to Accept Service by Mail - TANF Workshops | 09/01/2021 |
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DDD-2098A | Hourly Nursing Assessment Tool (H-NAT) | 09/01/2021 |
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CSE-1129A | Electronic Payment Authorization (English) | 09/01/2021 |
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CSE-1129A-S | Electronic Payment Authorization (Spanish) | 09/01/2021 |
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DDD-2101A | Electronic Visit Verification (EVV) Paper Timesheet Attestation (English) | 09/01/2021 |
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CSE-1281A | Agreement to Accept Service by Mail Paternity or Establishment (English/Spanish) | 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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