Dpaweb.hss.state.ak.us
Program Policy and Procedure Manuals DPAweb
WEBAdministrative Procedures Manual (04/24) Adult Public Assistance Manual (04/24) Aged, Disabled and Long Term Care Manual (04/24) Alaska Temporary Assistance Manual (04/24) Child Care Program Office Policy and Procedures Manual. Chronic and Acute Medical Assistance (04/23) DHSS Disaster Response and Recovery Guide. DHSS …
Actived: 7 days ago
E-Forms Index By Number DPAweb
WEBGEN 61 - General Relief Assistance Burial Pre-Authorization and Billing Form (e-form only) GEN 72 - Eligibility Review Form. GEN 80 - Child Support Cooperation Statement (e-form only) GEN 84 - All About Fair Hearings. GEN 85 - Fair Hearing Request. GEN 86 - Affidavit of Forgery (e-form only) GEN 87 - Complaint Form.
Medicaid Application for Adults and Children with Long Term …
WEB5. List any other money you or anyone in your household receives. Include Social Security, SSI, BIA, VA, retirement, unemployment insurance, Worker’s Compensation, Native assistance, child support, Virtual Currency/Cryptocurrency,
eForms Directory DPAweb
WEBDivision of Personnel Human Resources Forms (Dept of Admin) EIS and Network Services Security Agreement. Enterprise Technology Services (ETS) State HR Forms. Telecommunications Service Requests (TSR) Acrobat 5 Send Form Plug In Only for use with Acrobat Reader 5. DHSS Media Contact Form. DHSS Training Certification and …
Employment Statement
WEBEMPLOYMENT STATEMENT. In order to determine your eligibility for public assistance benefits, we need proof of your income. You can have your current or former employer complete this form or provide the needed information by submitting pay stubs, payroll records, or other employment documentation. If you decided to use this form, please …
Child's Medical History & Disability Report
WEBINFORMATION ABOUT YOUR TREATMENT. Give the name, address, and telephone number of medical providers, hospitals, or clinics. Where your child has received treatment for the condition(s) that disabled him/her. For more than five providers, make a copy of this blank page and attach. A. Name of physician/facility. Dates first/last treated.
Medicaid, Temporary Assistance, Food Stamp and Adult Public …
WEB2024 Temporary Assistance Standards. 2024 Adult Public Assistance Standards. 2024 Senior Benefits Standards. 2023 Senior Benefits Standards. FFY 2024 SNAP Standards Effective October 1, 2023 through September 30, 2024. FFY 2023 SNAP Standards Effective October 1, 2022 through September 30, 2023. FFY 2022 SNAP …
Supplemental Nutrition Assistance Program (SNAP) Interim …
WEBSupplemental Nutrition Assistance Program (SNAP) Interim Report Form. Please return this form by the 10th day of next month or your benefits will stop. We need the following information to determine if you are still eligible for Supplemental Nutrition Assistance Program (SNAP) benefits. Please complete and return this entire form to us by the
Report of Change
WEBThe Division of Public Assistance needs to know about these changes so we can determine your continued eligibility for assistance and benefit amount. Changes must be reported within 10 days of when you know of the change (5 days when a child leaves the home if you get Temporary Assistance). Attach proof of the change if you have it.
Monthly Self-Employment Business and/or Tip Ledger
WEBTitle: Monthly Self-Employment Business and/or Tip Ledger Author: HP Authorized Customer Subject: This form is intended to be printed and given to Public Assistance clients to record their self-employmen business expenses and tips.
Authorization for Release of Information
WEBAUTHORIZATION FOR RELEASE OF PROTECTED HEALTH INFORMATION. A separate release is needed for each provider, school, and school district (both past and present). Please fill out the form completely and do not use abbreviations. hereby authorize the above named health care provider or organization to release to the State of Alaska …
Qualifying Income Trusts
WEBQualifying Income Trusts. Steps to Take. If you decide to use a Qualified Income Trust to qualify for Medicaid, please take the following steps: 1. Find an attorney who is knowledgeable about trusts. You can contact Alaska Legal Services or the Alaska Bar Association and request referrals to attorneys specializing in Medicaid or Elder Law. 2.
APPENDIX C OPTIONAL Appointing an Authorized …
WEBThis person is called an “authorized representative.”. An authorized. representative can make changes to your Public Assistance case and has access to the information in your case file. You will be held responsible for any change that is made to your case by your appointed authorized representative, up to and including potential fraud charges.
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