Publications
Page 8 of 21
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W-682S - FORMULARIO DE AUTORIZACIÓN DE DEPÓSITO DIRECTO - Rev. 1-23
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Proof of Food Loss Form - Spanish
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Inter-Agency Patient Referral Form W-10
Inter-Agency Patient Referral Form Rev 02/23
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Request for Replacement SNAP Benefits
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W-675 - Report Form For Protective Services For The Elderly - Rev. 06/23
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W-300T19 - Medical Report For Title XIX Disability Determination - Rev.12-19
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Vendor Direct Deposit Form W-260
Vendor Direct Deposit Form
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HIPAA Authorization for Disclosure of Information W-298S
HIPAA Authorization for Disclosure of Information W-298S
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HIPAA Authorization for Disclosure of Information W-298
HIPAA Authorization for Disclosure of Information W-298
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Medicare Savings Program Application W-1QMB
Medicare Savings Program Application.
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SNAP ABAWD Work Requirement Medical Report W-1210
SNAP ABAWD Work Requirement Medical Report.
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W-944 - Notice of Action - Rev. 05-23
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Medicare Clearance Form.
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Acquired Brain Injury (ABI) Waiver Request Form W-1130
Application for Acquired Brain Injury (ABI) Waiver Request.
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CT Fatherhood Initiative Event to Focus on State Local Partnerships Supporting Families
The special role fathers play in raising children and supporting healthy families will be in the spotlight Thursday, May 3, when a coalition of state and private agencies invites the public to a special event at the Legislative Office Building.