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
1EditBH-11Behavioral Health Treatment Outcomes Program ManualDelete
1EditBH-03102a Hardship Considerations Delete
1EditEA-307GSNAP Group Home Exit FormDelete
1EditCPSIndependent Living Program Education and Training Voucher Delete
1EditBRO/MS3Well-Child Care BrochureDelete
1EditEA-301SNAP ApplicationDelete
1EditDSS-W9W-9 FormDelete
1EditBRO/CPS2Common Sense Parenting BrochureDelete
1EditPAPrior Authorization ManualDelete
1EditBH-11aAdult SUD Initial Outcome ToolDelete
1EditCCSPathways to Professional Development - Renewal ApplicationDelete
1EditENERGYVendor Information: Direct DepositDelete
1EditBRO/EA11Weatherization Assistance BrochureDelete
1EditEA-208Authorization to Furnish / Release InformationDelete
1EditEA-307SNAP Exit FormDelete
1EditCPSPlacement Resource Monthly Reporting Form Ages 14 and olderDelete
1EditSE-415Petition for Modification FormDelete
1EditPAPrior Authorization Forms: Private Duty Nursing & Extended Home Health ServicesDelete
1EditBRO/CCS3Registration & Licensure of Child Care EnvironmentsDelete
1EditBRO/EA1Energy Saving TipsDelete
1EditOS-954Client Authorized Debit for Repayment of OverissuanceDelete
1EditCPS-500Newborn Medical Report for Voluntary Termination of Parental RightsDelete
1EditBH-11cAdult SUD Discharge Outcome Tool Delete
1EditBH-04102b Hardship ConsiderationsDelete
1EditMSProviders: Adult Services & Aging Provider AgreementDelete
1EditBH-07Mental Health - Accreditation ApplicationDelete
1EditSE-431AChild Support Payment Authorization FormDelete
1EditBRO/DSS9DSS HandbookDelete
1EditBH-11bAdult SUD Update Outcome ToolDelete
1EditEA-320Self-Employment LedgerDelete
1EditPAPrior Authorization Forms: Durable Medical Equipment and NutritionDelete
1EditBRO/EA4TANF Work Program BrochureDelete
1EditEA-305Boarding School-Institution DocumentationDelete
1EditFACISInterstate Compact: Placement Request FormDelete
1EditBH-08Mental Health - IMPACT ApplicationDelete
1EditBRO/DCS8Child Support Parent HandbookDelete
1EditBH-11eAdult MH Update Outcome ToolDelete