Lynne A. Valenti
Cabinet Secretary

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Below you will find the selected forms and/or publications for this order. You will need to indicate the quantity you want to receive in the box next to the document number. After you have entered the quantity, click "Update" in the previous box. If you wish to remove a form or publication, simply click on the link that states "Delete." Once you have entered the quantity for each form or publication, click the "Proceed" button at the bottom.

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CopiesEdit the Number of CopiesDocument NumberDocument NameDelete
1EditEA-324Wage VerificationDelete
1EditBRO/EALong-Term Care Partnership BrochureDelete
1EditRec and FraudEstate Recovery Program Petition for LimitationDelete
1EditPAPrior Authorization Forms: Out-of State Services Delete
1EditCPSPlacement Resource Monthly Reporting Form Ages 5-13Delete
1EditBRO/EA5Medicare Savings Program BrochureDelete
1EditBRO/RE3Estate Recovery Program BrochureDelete
1EditEA-345Affidavit for SNAP Work RegistrantsDelete
1EditBRO/EBT1EBT Client HandbookDelete
1EditBRO/CPS18Family Group Conferencing – Provider Guide Delete
1EditBRO/CPS1Child Protection Services BookletDelete
1EditOS-950Recipient Forms: Title XIX Medical Transportation ReimbursementDelete
1EditBRO/EA9SNAP Shoppers GuideDelete
1EditEAWeatherization ApplicationDelete
1EditDSS-CCSRate Declaration FormDelete
1EditSE-492Notice of Shared Medical ExpensesDelete
1EditBH-11dAdult MH Initial Outcome ToolDelete
1EditCCS-950Child Care Assistance ApplicationDelete
1EditMSPrior Authorization Forms: Synagis Prior AuthorizationDelete
1EditBRO/ASA4Sexual Assault BrochureDelete
1EditMSHysterectomy Acknowledgement of InformationDelete
1EditBRO/DSS8Notice of Privacy BrochureDelete