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-208Authorization to Furnish / Release InformationDelete
1EditBRO/DSS8Notice of Privacy BrochureDelete
1EditCPSPlacement Resource Monthly Reporting Form Ages 14 and olderDelete
1EditCPSIndependent Living Program BrochureDelete
1EditCCSPayment Authorization FormDelete
1EditBRO/EA14Medical Assistance for Children and FamiliesDelete
1EditCCS-950Child Care Assistance ApplicationDelete
1EditDSS-CPSSafe Havens PosterDelete
1EditBRO/DCS2Teenage Parents Guide - How to Establish Paternity and Financial Support for your ChildDelete
1EditDSS-ORFI-831Estate Recovery Notification of Death FormDelete
1EditBRO/RE1Stop Benefit Fraud BrochureDelete
1EditBRO/EA9SNAP Shoppers GuideDelete
1EditCPS-549Request for Screening for Substantial Reports of Abuse and Neglect (unregistered family day care providers ONLY)Delete
1EditBRO/EA12Energy Assistance BrochureDelete
1EditBRO/EA18Long-Term Care Partnership BrochureDelete
1EditPAPrior Authorization Forms: Durable Medical Equipment and NutritionDelete
1EditEA-270Medical Savings Program ApplicationDelete
1EditSE408CPApplication and Agreement for Services - Custodial Parent and/or CaretakerDelete
1EditBRO/CPS15Family Group Conferencing – My Family Meeting Delete
1EditDSS-CCSRate Declaration FormDelete