You can search for reports, forms, policies and pamphlet and posters with information about specific programs and services.
Number | Document Name | Effective Date |
---|---|---|
FAA-1725A-S | Verificación de Otros Ingresos | 05/01/2023 |
GCI-1041A | Consent to Bill Health Insurance | 05/01/2023 |
FAA-1004A-S | Designation of EBT Alternate Card Holder (Spanish) | 05/01/2023 |
FAA-0257A | Individual Development Account Agreement (English) | 05/01/2023 |
FAA-1799A | Drug/Alcohol Treatment Center Training Acknowledgment | 05/01/2023 |
FAA-1249A-XLP | Verification of Disability (Extra Large Print) | 05/01/2023 |
FAA-1765A-S | Autoridad para Divulgar Información | 05/01/2023 |
FAA-0259A | Unwed Minor Parent Abuse/Neglect Claim | 05/01/2023 |
FAA-1494A | Authorized Representative Removal | 05/01/2023 |
FAA-0574A | Withdrawal or Stop Benefits/Appeal Request | 05/01/2023 |
Number | Document Name | Effective Date |
---|---|---|
LCR-1086A | Application for Child Developmental Home Certification | 01/01/2021 |
DDD-2086A | Support Coordinator Screening and Discharge for Occupational, Physical, and Speech Therapy | 01/01/2021 |
DDD-2063A | Ongoing Quarterly Progress Report (QPR) Plan of Care/Treatment Plan | 12/01/2020 |
CSE-0258A | Affidavit of Paternity Rescission (English/Spanish) | 12/01/2020 |
DDD-2036A | Member Funds Monthly Ledger (English) | 12/01/2020 |
CCA-0201A | Certification Statement for Providing Child Care Services | 12/01/2020 |
CCA-0201A-S | Declaración de Certificación para Proveer Servicios de Cuidado de Niños | 12/01/2020 |
CCA-1277A | Sample Child Care Provider Expulsion Prevention Policy (English) | 11/01/2020 |
CCA-1277A-S | Sample Child Care Provider Expulsion Prevention Policy (Spanish) | 11/01/2020 |
LCR-1030A | Request to Withdraw HCBS Certification | 10/01/2020 |
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