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-0574A-XLP | Withdrawal or Stop Benefits/Appeal Request (Large Extra Print) | 05/01/2023 |
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FAA-0574A-S | Retirar o Suspender Beneficios/Solicitud de Apelación | 05/01/2023 |
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FAA-1249A-XLP | Verification of Disability (Extra Large Print) | 05/01/2023 |
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FAA-0065A-LP | Verification of Living Arrangements/Residential Address - Large Print (English) | 05/01/2023 |
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CCA-1163A-S | Afidávit de Exención de Vacunación - Para Miembros del Hogar de 13 años de edad y Menores | 05/01/2023 |
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FAA-0574A-SXLP | Retirar o Suspender Beneficios/Solicitud de Apelación (Letra Extra Grande) | 05/01/2023 |
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FAA-1004A | Designation of EBT Alternate Card Holder (English) | 05/01/2023 |
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FAA-1494A-LP | Authorized Representative Removal (Large Print) | 05/01/2023 |
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FAA-1506A | Statement of No Income (English) | 05/01/2023 |
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FAA-1725A-S | Verificación de Otros Ingresos | 05/01/2023 |
Download | Number | Name | Effective Date |
---|---|---|---|
|
DDD-2090A | Program Integrity Requirements Verification | 03/01/2021 |
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DDD-2093A | DDD Behavioral Health Advocate Referral | 03/01/2021 |
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DDD-2092A | DDD Behavioral Health Advocacy Plan | 03/01/2021 |
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LCR-1087A | Child Developmental Certified Home Application Cover Page | 02/01/2021 |
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RSA-1298A | Referral Form (English) | 02/01/2021 |
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DDD-2087A | Documentation Guidelines: Occupational, Physical, and Speech-Language Pathology Therapy Services | 02/01/2021 |
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RSA-1298A-LP | Referral Form - Large Print (English) | 02/01/2021 |
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UB-010 | Eligibility Review Questionnaire (English) | 02/01/2021 |
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FAA-1796A | Affidavit of Visually Viewed Documentation | 02/01/2021 |
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UB-010-S | Eligibility Review Questionnaire (Spanish) | 02/01/2021 |
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