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-0098C | EBT Transaction Adjustment Hearing Request | 05/01/2023 |
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FAA-1004A-SLP | Designation of EBT Alternate Card Holder - Large Print (Spanish) | 05/01/2023 |
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FAA-1366A | Eligibility Requirements | 05/01/2023 |
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FAA-1004A-SXLP | Designation of EBT Alternate Card Holder - Extra Large Print (Spanish) | 05/01/2023 |
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FAA-1506A-S | Statement of No Income (Spanish) | 05/01/2023 |
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FAA-1533A | Verification of Unfitness for Work for Adults | 05/01/2023 |
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AAA-1296A | Protect Yourself and Medicare | 05/01/2023 |
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FAA-1701A-LP | Verification of Terminated Employment - Large Print (English) | 05/01/2023 |
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FAA-0065A-XLP | Verification of Living Arrangements/Residential Address - Extra Large Print (English) | 05/01/2023 |
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FAA-0051A | Verification of Financial Accounts (English) | 05/01/2023 |
Download | Number | Name | Effective Date |
---|---|---|---|
|
CCA-1212A-S | Puesto de Servicio Directo (Formulario de certificación) | 07/01/2021 |
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DDD-2104A | Member Interdisciplinary Team Summary | 07/01/2021 |
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DDD-2106A | Member's Circles of Support | 06/01/2021 |
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DDD-2107A-S | Hoja de Trabajo Sobre lo que Funciona y lo que no Funciona | 06/01/2021 |
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UIB-0098C | Eligibility Investigation Record - WC ALT. Base Period | 06/01/2021 |
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DDD-2106A-S | Círculos de Apoyo del Miembro | 06/01/2021 |
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UIB-0126A | Request for Reconsideration/Appeal (English) | 06/01/2021 |
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UIB-0126A-S | Request for Reconsideration/Appeal (Spanish) | 06/01/2021 |
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UIB-0098K | Eligibility Investigation Record - Transient Lodging Seasonal Employment | 06/01/2021 |
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UIB-0098M | Record of Employment | 06/01/2021 |
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