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-1353A | Affidavit Attesting Citizenship for Cash Assistance and Nutrition Assistance | 05/01/2023 |
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FAA-1494A-S | Remoción de un(a) Representante Autorizado(a) | 05/01/2023 |
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FAA-1004A-S | Designation of EBT Alternate Card Holder (Spanish) | 05/01/2023 |
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GCI-1033A-S | Resumen de la Conferencia de Transición | 05/01/2023 |
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FAA-1004A-XLP | Designation of EBT Alternate Card Holder - Extra Large Print (English) | 05/01/2023 |
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GCI-1037A | Public Education Agency (PEA) Notification/Referral | 05/01/2023 |
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GCI-1037A-S | Aviso o Recomendación de la Agencia de Educación Pública (PEA) | 05/01/2023 |
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FAA-0412A-SXLP | Change Report - Extra Large Print (Spanish) | 05/01/2023 |
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DDD-1345A | Medical Justification for Home Modifications (English) | 05/01/2023 |
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CCA-1170AS | Petición para el Retiro o Terminación de Solicitud - Para Proveedores de Cuidado de Niños | 05/01/2023 |
Download | Number | Name | Effective Date |
---|---|---|---|
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SNA-1066A | Voluntary Participation Agreement | 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 | Electronic Visit Verification (EVV) Designee Attestation (English) | 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-2102A-S | Electronic Visit Verification (EVV) Designee Attestation (Spanish) | 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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