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Download Number Form Name Effective Date
CCA-1200A-S Best of Care (Spanish) 06/01/2016
ESA-1297A Assurances for Interstate and Interstate Clearance Orders 05/01/2016
DDD-1532A Hardship Reduction Request 05/01/2016
CCA-1207A Notice of Monitoring Rights 05/01/2016
DDD-1532A-S Solicitud de Reducción Debido a Dificultad Económica 05/01/2016
UB-192 Employment Listing 05/01/2016
UB-192-S Employment Listing (Spanish) 05/01/2016
CCA-1207A-S Aviso Sobre Derechos de Monitorización - Verificación de Divulgación 05/01/2016
UB-194-FF Employer Verification or Requalifying Earnings 05/01/2016
SNA-1023AS Acuerdo Para Prácticas Laborales 04/01/2016

Download Number Form Name Effective Date
TANF Report 2005 TANF State Plan Effective 2005 Amended February 2007 10/01/2005
2005 Child Care Report to JLBC Child Care Report to JLBC 2005 09/29/2005
Family Support Program 2006 DDD Family Support Program Annual Report 2006 07/01/2005
Will Anyone Care April 2005 Will Anyone Care April 2005 04/01/2005
Annual Report 2003-2004 2003-2004 DES Annual Report 01/27/2005
DES Welfare-2004 DES Welfare Report 2004 12/31/2004
Annual Report on Homelessness 2004 13th Annual Report on Homelessness December 2004 12/01/2004
CCA Market Rate Survey 04 Child Care Market Rate Survey 2004 12/01/2004
Annual Report 2002-2003 2002-2003 DES Annual Report 02/02/2004
DES Welfare-2003 DES Welfare Report 2003 12/31/2003

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Download Number Form Name Effective Date
UB-092-A-S Declaración Financiera Confidencial 03/01/2018
FAA-1585A TANF Pre-Cooperation Interview/Entrevista de Cooperación TANF (Bilingual) 03/01/2018
UC-514 Report of Changes Form 03/01/2018
DD-099-A Pre-PAS Screening Tool Ages 0 Through 2 Years and 10 Months Old 03/01/2018
UIA-1004A Bulk Filer Application 03/01/2018
DD-099-B Pre-PAS Screening Tool for Members at Least 2 Years 10 Months Old, But Less than 6 Years Old 03/01/2018
DD-099-C Pre-PAS Screening Tool Only for Members between 6 and 11 Years Old 03/01/2018
UB-130A Work History 03/01/2018
DD-099-D Pre-PAS Screening Tool for Members At Least 12 Years Old 03/01/2018
UB-130A-S Experiencia de Trabajo 03/01/2018

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