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Eforms Alphabetical List
SFN #
Form Title
E-Forms
150
60 Month Lifetime Exemption Background Report
X
478
ADD New Record to MMIS Elig File
385
Affidavit For FS Work Registrants
X
1445
Agreement for Real Property Exclusion & Repayment of TANF Grant
X
411
Aid to the Blind/Remedial Denial Notice
X
1906
Anticipated Self-Employment Worksheet
X
23
APP For Approval For Relative Child Care Provider
X
1784
Appeal Background Report
X
502
Application for Health Care Coverage
X
405
Application For Medicaid, TANF, FS, & CCA
X
200
Asset Assessment
X
560
Assignment of Benefits
X
1059
Authorization to Disclose Information
X
208
Card Problem Report
X
98
Case Management Inter-Agency Referral
X
701
Case Review Short Form
X
700
Case Transfer Log
X
378
Change Report Form
598
Child Care Assistance Application
X
354
Child Care Assistance Prog Estimate of Day Care Req
841
Child Care Assistance Redetermination Form
X
848
Child Care Assistance Provider Request to Pay Parent Directly
X
338
Child Care Checklist
X
616
Child Care Service Report and Bill
X
152
Child Support Verification
X
540
Confidential Report of Job Service Unemployment
X
880
Contractual Right to Receive Money Payments Valuation Request
X
370
Coupon Book Lost in Mail
827
Credit Form (Misc. Programs)
X
828
Credit Form (Medical Programs)
X
321
Daily Card Issuance Log
X
242
Daily Issuance Report
132
Dependent Care Payments
X
737
Diversion Assistance Action Plan
X
735
Diversion Assistance Screening
X
376
Drug-Related Felony Review
X
325
EBT Card Stock Transfer
X
596
EBT Training Referral
530
Eligibility and Benefit Worksheet Energy
X
451
Eligibility Report on Disability/Incapacity
X
11
Emergency Assistance Action Plan
X
62
Emergency Assistance Application
38
Emergency Assistance Service Application
X
13660
Employer's Report of Injury (Worker's Comp form)
X
671
Employment Communication Attendance Roster
679
Employment Communication Orientation Referral
X
53401
Energy Assistance - Request for Payment
529
Energy Assistance Program Application
X
527
Family Coverage Budget Worksheet
X
336
Food Stamp Benefit Conversion Notice
362
Food Stamp Computation Sheet
X
337
Food Stamp Program Claim Review
X
488
FSP Very Short Case Review
X
202
Group Home Drug/Alchohol Treatment Center Monthly Listing
X
788
Group Living Arrangement & Drug/Alcohol Treatment Center Report
X
1076
Growers Statement
X
817
Health Insurance Cost-Effective Review
X
1540
Income Annualizing/Averaging Worksheet
X
873
Income Calculation Worksheet (IV-E)
X
413
Individual Indian Monies Account
X
740
Initial/Strength/Full Assessment
X
323
JOBS Status Change
X
423
Kinship Placement
X
424
Kinship Care Agreement
X
426
Kinship Care Study
X
443
Notice of Right to Claim Good Cause
X
655
Liheap Case Review
X
687
Medicaid Budget Worksheet
X
615
Medicaid Program Provider Agreement
X
1224
Medical /Child Support Questionnaire
X
187
Medical Expense Worksheet
X
429
Memo Agreement to Establish Protective Payments
X
339
Monthly Case Management Billing And Reporting
X
319
Monthly EBT Inventory Control Log
X
407