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Reports, Forms, Pamphlets and Policies

You can search for reports, forms, policies and pamphlet and posters with information about specific programs and services.

Click on the tab that corresponds with the type of document type you are looking for, or click on the "All Documents" tab to search through all available documents. You can refine your search by selecting a category from the Filter by Category drop-down.
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Number	Document Name	Effective Date
FAA-0255A-S	Afirmación De Hogares Por Separado	05/01/2023
DDD-0211A	Home Modifications Service Referral and Request (English)	05/01/2023
CCA-1163A	Affidavit of Immunization Exemption - For Household Members Age 13 and Younger (English)	05/01/2023
FAA-0574A-S	Withdrawal or Stop Benefits/Appeal Request (Spanish)	05/01/2023
FAA-0255A	Separate Household Status Statement	05/01/2023
FAA-0065A-S	Verification of Living Arrangements/Residential Address (Spanish)	05/01/2023
AAA-1296A	Protect Yourself and Medicare	05/01/2023
FAA-1768A	Overpayment Compromise Request Form (English)	05/01/2023
DDD-1345A	Medical Justification for Home Modifications (English)	05/01/2023
CCA-1163A-S	Affidavit of Immunization Exemption - For Household Members Age 13 and Younger (Spanish)	05/01/2023

Number	Document Name	Effective Date
RSA-TT5650	Transition Protocol form	06/25/2010
RSA-LP5651	Transition Protocol (Large Print)	06/25/2010
AG-031-R	Social Service Report and Instructions for Registered Services	03/01/2010
AG-030-A-FF	Congregate Meals Report	07/01/2009
AG-030-B-FF	Home Delivered Meals Report	07/01/2009
DDD-1505A	Seizure Record	05/01/2009
AAA-1174A	SHIP/SMP Volunteer Application	02/01/2009
DDD-1725A	Uniform Billing Document (Short form)	12/17/2008
DDD-1482A	Do Your Business a Favor...Hire a Person with a Disability	05/01/2008
WOTC - How to Qualify and Participate	Work Opportunity Tax Credit-How to Qualify and Participate	02/01/2008

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