Form
Document used for application, enrollment, registration or eligibility determination purposes.
Effective Date	Title - Owner - Description
11/24/2009	Form 752A, Authorization for Release of Protected Health Information - Division of Family Assistance - Form 752A is an Authorization for Release of Protected Health Information.
11/24/2009	Form 800, Application for Assistance, Solicitud para asistencia, Zahtjev - Division of Family Assistance - Application to apply for Food Stamps, financial assistance, child care assistance, emergency assistance and medical assistance. Solicitud para asistencia. Zahtjev.
07/01/2009	Form 752 Physician-Clinician Statement of Capabilities - Division of Family Assistance - Form 752 Physician-Clinician Statement of Capabilities to determine if you are unable to work or participate in NHEP activities because you have a current medical condition.
07/01/2009	Form 752HH Physician/Clinician Statement of Necessary Patient Care For A Household Member - Division of Family Assistance - Form 752HH - Physician/Clinician Statement of Necessary Patient Care For A Household Member to evaluate if you are unable to work or participate in NHEP activities because you have to take care of certain individuals.
06/30/2009	Client and Provider Instructions-Form 752, 752 A, 752 H - Division of Family Assistance - Client and Provider Instructions for Completion, and/or Processing of: Form 752, Form 752 A and Form 752HH.
04/01/2008	Your Rights and Responsibilities - Division of Family Assistance - Provides a description of client rights and responsibilities when applying for and receiving any Division of Family Assistance program of assistance.
07/01/2007	Employment Verification Form 756 - Division of Family Assistance - Employment Verification Form 756 is used by the Division of Family Assistance to collect needed information and provides accurate wage information.
04/01/2006	Authorized Representative Declaration - Division for Family Assistance - Allows an applicant or recipient to name authorized representative.
02/01/2006	Form 800R, Review For Continued Eligibility - Division of Family Assistance - Review For Continued Eligibility for Financial, Medical and Food Stamp Benefits.
05/01/2004	Rental Verification Request - Division of Family Assistance - Used by the Division of Family Assistance to collect rental verification information for subsidized and non-subsidized housing.