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Download Number Form Name Effective Date
FAA-0574A-XLPS Retirar o Suspender Beneficios/Solicitud de Apelación (Letra Extra Grande) 07/01/2019
FAA-0837A Authorization to Open an IDA 08/01/2019
FAA-1004A Designation of EBT Alternate Card Holder 07/01/2018
FAA-1004A-S Designación de Titular Sustituto para la Tarjeta de EBT 07/01/2018
FAA-1055A Spread the Word (Eng/Span) 05/01/2015
FAA-1097A Young Adult Transitional Insurance (YATI) Referral 09/01/2017
FAA-1111A Participant Statement Verification Worksheet 06/01/2019
FAA-1111A-S Hoja para Verificar la Declaración del Participante 06/01/2019
FAA-1208A Language Notification Flyer 11/01/2014
FAA-1249A Verification of Disability 07/01/2019

Download Number Form Name Effective Date
30th Month Aug-2015 30th Month Report August Fiscal Year 2015 10/27/2014
30th Month Aug-2016 30th Month Report August Fiscal Year 2017 10/27/2016
30th Month Aug-2016 30th Month Report August Fiscal Year 2016 10/14/2015
30th Month Aug-2017 30th Month Financial Report FY-2018 through Aug-2017 11/07/2017
30th Month Aug-2018 30th Month Financial Report FY-2019 through Aug-2018 12/12/2018
30th Month Dec 2017 30th Month Financial Report FY-2018 through Dec-2017 02/28/2018
30th Month Dec-2010 30th Month Report December Fiscal Year 2010 12/01/2009
30th Month Dec-2011 30th Month Report December Fiscal Year 2011 02/11/2011
30th Month Dec-2012 30th Month Report December Fiscal Year 2012 02/15/2012
30th Month Dec-2015 30th Month Report December Fiscal Year 2015 02/27/2015

No results available.

Download Number Form Name Effective Date
CCA-1253A Choosing Quality Child Care (English/Spanish) 04/01/2019
CSE-1043A What Every Parent Should Know About Establishing Paternity 05/01/2018
CSE-1043A-S LO QUE TODOS LOS PADRES DEBERÍAN SABER SOBRE EL ESTABLECIMIENTO DE LA PATERNIDAD 05/01/2018
CSE-1051A How to Apply for IV-D Child Support Services 06/01/2019
CSE-1051AS Cómo Solicitar Servicios de Sustento para Menores Bajo el Título IV-D 02/01/2014
CSE-1061A Establishing Paternity 07/01/2018
CSE-1061A-S Establecer la Paternidad 07/01/2018
CSE-1084A How Much Do I Owe? 10/01/2013
CSE-1084AS ¿Cuánto Adeudo? 10/01/2013
CSE-1154A DCSS e-Employer Program 02/01/2016


Download Number
 		Form Name Effective Date
FAA-0077A-SLP Solicitud de Información y Acuerdo para Proporcionar Información que Falta (Letra Grande) 10/01/2019
FAA-0077A-XLP Information Request and Pending Information Agreement (Extra Large Print) 10/01/2019
FAA-0077A-XLPS Solicitud de Información y Acuerdo para Proporcionar Información que Falta (Letra Extra Grande) 10/01/2019
FAA-0526A Potential Overpayment (OP) Referral 08/01/2019
FAA-0574A Withdrawal or Stop Benefits/Appeal Request 07/01/2019
FAA-0574A-LP Withdrawal or Stop Benefits/Appeal Request (Large Print) 07/01/2019
FAA-0574A-LPS Retirar o Suspender Beneficios/Solicitud de Apelación (Letra Grande) 07/01/2019
FAA-0574A-S Retirar o Suspender Beneficios/Solicitud de Apelación 07/01/2019
FAA-0574A-XLP Withdrawal or Stop Benefits/Appeal Request (Large Extra Print) 07/01/2019
FAA-0574A-XLPS Retirar o Suspender Beneficios/Solicitud de Apelación (Letra Extra Grande) 07/01/2019

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