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
1EditBRO/CCS14Choosing Child Care HandbookDelete
1EditPAPrior Authorization Forms: SynagisDelete
1EditEA-214TANF 6 Month Report FormDelete
1EditBH-14Substance Abuse - Accreditation ApplicationDelete
1EditBH-18Mental Health - Indigent Medication Update - Extension Form 1.0Delete
1EditCCSPayment Authorization FormDelete
1EditBRO/EA9SNAP Shoppers GuideDelete
1EditBRO/DCS4National Medical Support Notice Brochure - An Employers GuideDelete
1EditBRO/DCS6Voluntary Paternity Establishment Handbook and FormDelete
1EditPAPrior Authorization Forms: BRCADelete
1EditCPSPotential Placement StatementDelete
1EditEA-320Self-Employment LedgerDelete
1EditCPS-594Declaration of Prior Criminal Conviction & Military HistoryDelete
1EditBH-01Federal Poverty Level GuidelinesDelete
1EditPAPrior Authorization Forms: GeneralDelete
1EditDSSRecipient Forms: Psychiatric Residential Treatment Facility Referral FormDelete
1EditEA-270Medical Savings Program ApplicationDelete
1EditBRO/CPS18Family Group Conferencing – Provider Guide Delete
1EditBRO/DSS2Constituent Liaison Services BrochureDelete
1EditEA-345AAffidavit for SNAP Work Registrants (Employment & Training)Delete
1EditEAWeatherization ApplicationDelete
1EditBRO/EA18Long-Term Care Partnership BrochureDelete
1EditCPS-565Foster Parent Training & Self-InstructionDelete
1EditEA-310Form for Reporting ChangesDelete