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APPLICATIONS
7200 - Food Assistance and/or OWF Cash Assistance Application
7216- Medicaid Only Application
2399- Request for Medicaid Home and Community Based Services
7204 - Reapply for Food Assistance and / or Cash Assistance Application
MEDICAL ASSISTANCE
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Authorized Representative Form
Declaration of self-employment income
Community Services Brochure
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Explanation of State Hearing Procedures (4059)
IAR (Authorization for Reimbursement of Interim Assistance Initial Payment
)
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PERS Independent Contractor Acknowledgment
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