EDITS - Enrollment Announcement and Form Submission
 
 
Saturday, July 04, 2015
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Doc Category Cat Description Doc Type Document Description
01 Personal Documents 1778 "I-94 - stamped ""CU6 or CU7""
01 Personal Documents 6995 "K" VISA
01 Personal Documents 6997 "S" VISA
01 Personal Documents 6999 "U" VISA
01 Personal Documents 7000 "V" VISA
01 Personal Documents 0236 Adoption Papers
01 Personal Documents 1838 Affidavit sworn u/penalty o/law s/he Hmong/Laotion betw 8/5/64&5/7/75
01 Personal Documents 7859 Afghan passport admitted under 101(a)(27) of the INA
01 Personal Documents 7862 Afghan Passport stamped admitted under SI-1, SI-2, SI-3
01 Personal Documents 7863 Afghan Passport stamped admitted under SQ-1, SQ-2, SQ-3
01 Personal Documents 7867 Afghan Passport stamped SQ-6, SQ-7, SQ-9, SI-6, SI-7, SI-9
01 Personal Documents 7860 Afghan Passport with stamp showing admitted under101(a)(27of the INA
01 Personal Documents 1044 AFIS Photo
01 Personal Documents 7704 Any authoritative document from the USCIS indicating deferred action
01 Personal Documents 7497 Any other USCIS document ind alien has a K or V visa
01 Personal Documents 6986 Any verification from US Immigration or other authoritative documents
01 Personal Documents 6906 Armed Forces Serial Number
01 Personal Documents 0044 Baptismal Certificate
01 Personal Documents 6802 Baptismal Certificate with place and date of birth in USA/Territories
01 Personal Documents 7779 Begin 3-month ISP Progress Report Language Workstudy or Workstudy
01 Personal Documents 7780 Begin 6-month ISP Progress Report Language Workstudy or Workstudy
01 Personal Documents 7781 Begin 9-month ISP Progress Report Language Workstudy or Workstudy
01 Personal Documents 7538 Begin Absence Documentation
01 Personal Documents 7782 Begin Final ISP Progress Report Language Workstudy or Workstudy
01 Personal Documents 7786 Begin Participant Worksite Evaluation 3-month Language Workstudy-Work
01 Personal Documents 7787 Begin Participant Worksite Evaluation 6-month Language Workstudy-Work
01 Personal Documents 7788 Begin Participant Worksite Evaluation 9-month Language Workstudy-Work
01 Personal Documents 7783 Begin POP Assessment Form Employment Plus
01 Personal Documents 7785 Begin Work Skills Interest Form Internship
01 Personal Documents 7784 Begin Work Skills Interest Form Language Workstudy or Workstudy
01 Personal Documents 8461 BFI-Copy of Warrant
01 Personal Documents 8462 BFI-Rap Sheet and Photo
01 Personal Documents 0008 Birth Certificate Bureau of Vital Statistics
01 Personal Documents 8196 Birth Certificate from Puerto Rico Issued on or After 7/1/2010
01 Personal Documents 7122 Birth or baptismal cert issued on a reservation
01 Personal Documents 0004 Birth/Hospital Certificate
01 Personal Documents 6801 Birth/Hospital Certificate with place of birth within USA/Territories
01 Personal Documents 1690 CBIC-Common Benefit Identification Card
01 Personal Documents 6903 Census Records
01 Personal Documents 1076 Certificate from Commission for the Blind
01 Personal Documents 1766 Certificate of Domestic Partnership
01 Personal Documents 7807 CHAT- CAS Determination Letter
01 Personal Documents 7809 CHAT- Confidentiality Agreements
01 Personal Documents 7804 CHAT- Homelessness Hx Documentation
01 Personal Documents 7808 CHAT- NESHA Applications
01 Personal Documents 7805 CHAT- Substance Abuse Tx Documentation
01 Personal Documents 7806 CHAT- TB Documentation
01 Personal Documents 7803 CHAT- W-900W Psychiatric Evaluation
01 Personal Documents 7802 CHAT- W-900X Psychosocial Assessment
01 Personal Documents 0932 Court or Agency Placement Papers
01 Personal Documents 6994 Court order granting suspension of deportation pursuant to sec 244
01 Personal Documents 0228 Court Records clearly establishing relationship
01 Personal Documents 6899 Criminal Court Records
01 Personal Documents 7964 CS-925 Application For Child Care Subsidy
01 Personal Documents 7443 Current Letter from Registrar's or Bursar's office
01 Personal Documents 7530 Current Military Orders
01 Personal Documents 0055 DD-214 Certificate of Release or Discharge from Active Duty
01 Personal Documents 0084 DD-214 Discharge Certificate that states Honorable
01 Personal Documents 0240 Death Certificate relationship
01 Personal Documents 1080 Disability Certificate from NYS or NYC Disability Review Team
01 Personal Documents 5766 Discharge to Foster Care Placement with Special Services for Children
01 Personal Documents 0080 Divorce Separation Annulment Papers
01 Personal Documents 0196 Doctor Clinic Pregnancy Statement with EDC Date
01 Personal Documents 7438 Doctor's records
01 Personal Documents 8460 Document from religious org stating SSN is in conflict with doctrine
01 Personal Documents 1832 Document verifying that individual was receiving MA on 8/24/97
01 Personal Documents 7375 Documentation certifying need for Other Special Grant request
01 Personal Documents 7701 Documents from the USCIS indicating an Order of Supervision
01 Personal Documents 7171 Documents verifying need for emgency child care payment reimbursement
01 Personal Documents 0036 Driver's License
01 Personal Documents 7572 DS-1350 Certification of Report of Birth
01 Personal Documents 8198 DSP-Consultative Examination Results
01 Personal Documents 5502 DSS-3367 Refugee and Cuban Haitian Entrant Reporting
01 Personal Documents 5438 DSS-4060 Declaration of Citizenship Immigration Status
01 Personal Documents 9080 Employment Authorization Card Form I-766 Category C33
01 Personal Documents 8000 Employment Authorization Document
01 Personal Documents 0024 EPFT-Photo ID with Signature
01 Personal Documents 1872 Evidence of battery and abuse
01 Personal Documents 6513 EXP-191N Certification of Citizenship or Alien Status
01 Personal Documents 8349 FIA-1046 Home Visit Needed/Homebound Status Extended for Ninety Days
01 Personal Documents 8294 Field Visit Report HASA
01 Personal Documents 0040 Foreign Passport
01 Personal Documents 6979 Form I-220B (Order of Supervision)
01 Personal Documents 7571 FS-240 Consular Report of Birth
01 Personal Documents 1824 Grant letter from Asylum Office of US Immigration
01 Personal Documents 8020 Guardian Ad Litem
01 Personal Documents 7905 HA 4631 Claimant's Medical Treatment
01 Personal Documents 7906 HA 4632 Claimant's Medications
01 Personal Documents 7907 HA 4633 Claimant's Work Background
01 Personal Documents 8008 HASA Court Documentation
01 Personal Documents 8626 HASA Financial Management Package
01 Personal Documents 8009 HASA Medical Documentation
01 Personal Documents 1853 HASA Only-Attorney letter verifying appl deferred Immigration action
01 Personal Documents 9025 Health Care Proxy
01 Personal Documents 0188 Health Ins Plan ID-Statement
01 Personal Documents 6907 Health Insurance Card with Social Security Number
01 Personal Documents 0056 High School College Degree
01 Personal Documents 1702 High School Diploma GED Certificate
01 Personal Documents 8292 Home Care Package HASA
01 Personal Documents 8291 Homemaking Package HASA
01 Personal Documents 0016 Hospital Letter for newborns
01 Personal Documents 0176 Hospital Release Papers
01 Personal Documents 6828 I-181 Memo of Creation of Lawful Permanent Residence w approval stamp
01 Personal Documents 0148 I-210 Voluntary Departure
01 Personal Documents 6990 I-210 Voluntary Departure
01 Personal Documents 0152 I-220B Order of Supervision
01 Personal Documents 0116 I-279 I-97 Resident Citizen ID
01 Personal Documents 0132 I-327 Re-entry Permit of Permanent Residents
01 Personal Documents 7079 I-485 Application to Register Permanent Resident or Adjust Status
01 Personal Documents 7858 I-539 Application to Extend/Change Non-immigrant Status
01 Personal Documents 0124 I-551 Alien Registration Card
01 Personal Documents 1798 I-551 Alien Registration Card stamped "AM1,AM2,AM3,AM6,AM7,AM8"
01 Personal Documents 8637 I-551 Alien Registration Card stamped "ST0"
01 Personal Documents 8638 I-551 Alien Registration Card stamped "ST6"
01 Personal Documents 8639 I-551 Alien Registration Card stamped "ST7"
01 Personal Documents 8640 I-551 Alien Registration Card stamped "ST8"
01 Personal Documents 8641 I-551 Alien Registration Card stamped "ST9"
01 Personal Documents 7866 I-551 Alien Registration stamped SQ-6, SQ-7, SQ-9, SI-6, SI-7, SI-9
01 Personal Documents 1804 I-551 stamped in foreign passport or on I-94 Unexpired temporary
01 Personal Documents 1796 I-551Alien Registration Card stamped "CU6, CU7 or CH6"
01 Personal Documents 1818 I-571 Refugee Travel Document
01 Personal Documents 6983 I-688 Employment Authorization Card coded 274a.12(a)(11) or A11
01 Personal Documents 6991 I-688 Employment Authorization Card coded 274a.12(c)(10) or C10
01 Personal Documents 6988 I-688 Employment Authorization Card coded 274a.12(c)(14) or C14
01 Personal Documents 6800 I-688 Employment Authorization Card coded 274a.12(c)(18) or C18
01 Personal Documents 0136 I-688 Temporary Residence Card
01 Personal Documents 7738 I-688A coded 245A
01 Personal Documents 7715 I-688B (EAD) cat. 8 CFR 274a12(a)(15) or A15
01 Personal Documents 7705 I-688B (EAD) cat. 8 CFR 274a12(a)(9) or A9
01 Personal Documents 7717 I-688B (EAD) cat. 8 CFR 274a12(c)(16) or C16
01 Personal Documents 7708 I-688B (EAD) cat. 8 CFR 274a12(c)(21) or C21
01 Personal Documents 8683 I-688B (EAD) category 8 CFR 274a.12 (a)(14) or A(14)
01 Personal Documents 7731 I-688B (EAD) coded 27a12(c)(19) or C19
01 Personal Documents 7729 I-688B (EAD) coded 8 CFR 274a12(a)(12) or A12
01 Personal Documents 7723 I-688B (EAD) coded 8 CFR 274a12(a)(8) or A8
01 Personal Documents 7726 I-688B (EAD) coded 8 CFR 274a12(c)(8) or C8
01 Personal Documents 7733 I-688B (EAD) coded 8 CFR 274a12(c)(9) or C9
01 Personal Documents 9079 I-688B cat C10 Employment Auth Card notated 8 CFR 274a.12(c)(10)
01 Personal Documents 7739 I-688B coded 8 CFR 274a12(c)(22) or C22
01 Personal Documents 1060 I-688B Employment Authorization Card
01 Personal Documents 8350 I-688B Employment Authorization Card coded 274a.12(a)(19) or A19
01 Personal Documents 8351 I-688B Employment Authorization Card coded 274a.12(a)(20) or A20
01 Personal Documents 9077 I-766 (EAD) annotated a3, (a3), A3 or A03
01 Personal Documents 7716 I-766 (EAD) cat. 8 CFR 274a12(a)(15) or A15
01 Personal Documents 7718 I-766 (EAD) cat. 8 CFR 274a12(c)(16) or C16
01 Personal Documents 7709 I-766 (EAD) cat. 8 CFR 274a12(c)(21) or C21
01 Personal Documents 7706 I-766 (EAD) cat. CFR 274a12(a)(9) or A9 or A09
01 Personal Documents 8684 I-766 (EAD) category 8 CFR 274a.12 (a)(14) or A14
01 Personal Documents 7732 I-766 (EAD) coded 27a12(c)(19) or C19
01 Personal Documents 7730 I-766 (EAD) coded 8 CFR 274a12(a)(12) or A12
01 Personal Documents 7724 I-766 (EAD) coded 8 CFR 274a12(a)(8)or A8 or A08
01 Personal Documents 7727 I-766 (EAD) coded 8 CFR 274a12(c)(8) or C8 or C08
01 Personal Documents 7734 I-766 (EAD) coded 8 CFR 274a12(c)(9) or C9 or C09
01 Personal Documents 7529 I-766 annotated C11 or A4 & I-94 indicating admitted at least one year
01 Personal Documents 9078 I-766 cat C10 Employment Auth Card notated 8 CFR 274a.12(c)(10)
01 Personal Documents 8689 I-766 cat code A19, A20 & exp date<4 yrs fr date of application
01 Personal Documents 7740 I-766 coded 8 CFR 274a12(c)(22) or C22
01 Personal Documents 6984 I-766 Employment Authorization Card coded 274a.12(a)(11) or A11
01 Personal Documents 8352 I-766 Employment Authorization Card coded 274a.12(a)(19) or A19
01 Personal Documents 8353 I-766 Employment Authorization Card coded 274a.12(a)(20) or A20
01 Personal Documents 6992 I-766 Employment Authorization Card coded 274a.12(c)(10) or C10
01 Personal Documents 6989 I-766 Employment Authorization Card coded 274a.12(c)(14) or C14
01 Personal Documents 6978 I-766 Employment Authorization Card coded 274a.12(c)(18) or C18
01 Personal Documents 1814 I-766 Employment Authorization Document annotated A5 or A05
01 Personal Documents 8635 I-766 Employment Authorization Document annotated (a)(16) or A16
01 Personal Documents 8636 I-766 Employment Authorization Document annotated c(25) or C25
01 Personal Documents 7725 I-797 Asylum Application received, pending or approve asylum request
01 Personal Documents 7707 I-797 document indicating application for I-130 is pending/approved
01 Personal Documents 7711 I-797 Early "U" VISA Application Notice of Deferred Action
01 Personal Documents 7735 I-797 indicating application received, pending or approved
01 Personal Documents 7499 I-797 indicating approved I-130 visa petition
01 Personal Documents 1875 I-797 indicating receipt (pending) I-360 self-petition under VAWA
01 Personal Documents 7728 I-797 indicating TPS status granted
01 Personal Documents 6987 I-797 Notice of Action/other form show appr of deferred action status
01 Personal Documents 7719 I-797 Notice of Status to Permanent Resident pursuant - INA Sec 249
01 Personal Documents 9084 I-797 or USCIS or EOIR doc I-765 mentioning cat class or type C33
01 Personal Documents 9081 I-797 or USCIS or EOIR doc indic approval Form I-765 cat class or type C33
01 Personal Documents 9082 I-797 or USCIS or EOIR document approval of USCIS Form 1-821D
01 Personal Documents 9085 I-797 or USCIS or EOIR document pending USCIS Form I-821D
01 Personal Documents 1772 I-94 - Section 212(d)(5) of the INA"
01 Personal Documents 7002 I-94 and I-210 indicating departure on a specific date
01 Personal Documents 7700 I-94 annotated "Order of Supervision"
01 Personal Documents 7736 I-94 or stamp in passport annotated "adjustment application"
01 Personal Documents 7737 I-94 or stamp in passport annotated, "employment authorized"
01 Personal Documents 1780 I-94 stamped " AM1, AM2, AM3, AM6, AM7, AM8 "
01 Personal Documents 7722 I-94 stamped "DS" (Duration of Status)
01 Personal Documents 6980 I-94 stamped "Granted an indefinite stay of deportation"
01 Personal Documents 6985 I-94 stamped "Granted indefinite volunt departure status under sec 244
01 Personal Documents 6993 I-94 stamped "Granted suspension of deportation pursuant to sec 244"
01 Personal Documents 7712 I-94 stamped "U1", "U2", "U3" or "U4"
01 Personal Documents 7714 I-94 stamped "V1", "V2", "V3"
01 Personal Documents 0128 I-94-Stamp in Passport
01 Personal Documents 6914 Insurance or Health policy card
01 Personal Documents 7886 Iraqi passport admitted under 101(a)(27) of the INA
01 Personal Documents 7864 Iraqi Passport stamped admitted under SI-1, SI-2, SI-3
01 Personal Documents 7865 Iraqi Passport stamped admitted under SQ-1, SQ-2, SQ-3
01 Personal Documents 7868 Iraqi Passport stamped SQ-6, SQ-7, SQ-9, SI-6, SI-7, SI-9
01 Personal Documents 7861 Iraqi Passport with stamp showing admitted under101(a)(27 of the INA
01 Personal Documents 7667 IREA L&R Personal Injury Liens
01 Personal Documents 8977 l-766 (EAD) annotated a3, (a3), A3 or A03
01 Personal Documents 8290 Legal Documentation HASA
01 Personal Documents 7004 Letter acknowldg alien's presence in US w/stmt that deportation is not enforced
01 Personal Documents 0092 Letter from Community Institution ID
01 Personal Documents 0164 Letter from Hospital Social Worker
01 Personal Documents 8044 Letter From Primary Tenant Verifying Residence
01 Personal Documents 0940 Letter from U.S. Justice Department
01 Personal Documents 7721 Letter from USCIS acknowledging the alien's presence in the US
01 Personal Documents 1836 Letter or Tribal document certifying at least 50 Amer.Indian Blood
01 Personal Documents 8309 M-322h Pregnancy Benefits and Your Responsibility to Report Childbirth
01 Personal Documents 8034 M-327m Mailer Notice to Return Documents/Report to the Job Center
01 Personal Documents 7146 M-76k Consent for a Substance Abuse Assessment of a Minor
01 Personal Documents 7692 M-76M Consent for Release of HIV and Related Information
01 Personal Documents 7691 M-76N Alcohol & SA Treatment Records
01 Personal Documents 6266 MAP /E E1406 Change of Address Questionnaire
01 Personal Documents 1032 MAP-480W Birth of Cash Assist-Participant/Managed Care Enroll W-538D
01 Personal Documents 7935 MAP-635P Referral For A Face To Face Interview
01 Personal Documents 0012 Marriage Certificate with DOB
01 Personal Documents 0048 Marriage Certificate without DOB
01 Personal Documents 0064 Medicaid Card
01 Personal Documents 6069 Medical Examination of Aliens Seeking Adjustment of Status
01 Personal Documents 0920 Medicare Acceptance Letter or Statement
01 Personal Documents 0068 Medicare Card
01 Personal Documents 7198 Medicare Drug Discount Card
01 Personal Documents 1878 Membership card or Tribal doc. for federally recognized tribe-Sec4(e)
01 Personal Documents 0028 Military ID DD Form 2 Active with expiration date more than 1 year
01 Personal Documents 0180 Military Retirement Disability Papers
01 Personal Documents 0108 N550,N570 Certificate of Naturalization
01 Personal Documents 0104 N560 Certificate of Citizenship
01 Personal Documents 7586 Non-Citizen Referral to SSA for Social Security Number FA and or FS
01 Personal Documents 0900 Non-Driver's License
01 Personal Documents 6981 Notice/letter showing cont exclusion/deportation proceeding
01 Personal Documents 9037 NYPD Domestic Incident Report
01 Personal Documents 9022 NYS Enhanced Driver’s License
01 Personal Documents 9023 NYS Enhanced Non-Driver’s ID Card
01 Personal Documents 6267 NYS Finger Imaging System-Records Management Fingerprint and Photo ID
01 Personal Documents 8749 OCSE-191 Notice to Respondent
01 Personal Documents 7702 Order fr EOIR granting cancellation of removal
01 Personal Documents 1826 Order from immigration judge granting asylum
01 Personal Documents 6807 ORR Certification Letter
01 Personal Documents 6808 ORR Letter for Children
01 Personal Documents 0100 Other Acceptable ID
01 Personal Documents 0160 Other Citizenship
01 Personal Documents 1052 Other Proof of Child's Temporary Absence
01 Personal Documents 0204 Other Proof of Non-Residence-NYS
01 Personal Documents 7126 Other Public records that can show residence in the U.S. From 1972
01 Personal Documents 7713 Other USCIS authoritative document that verifies "U" visa status
01 Personal Documents 1860 Passport - with stamp showing alien status and date status granted
01 Personal Documents 0060 Photo ID any source
01 Personal Documents 0232 Physician's Statement of Birth & Parentage relationship
01 Personal Documents 5002 Power of Attorney
01 Personal Documents 0072 Prison Arrest Parole Records
01 Personal Documents 0168 Prison Release Papers
01 Personal Documents 6326 Receipt for I-90 Submitted Without Fee
01 Personal Documents 8195 Refugee Training Program
01 Personal Documents 0120 Reporting Birth of US Citizen Abroad FS240,FS545,DS1350
01 Personal Documents 7442 School letter with expected date of graduation
01 Personal Documents 0020 Selective Service Registration Certificate
01 Personal Documents 0244 Social Security Card
01 Personal Documents 1258 SS5 Application for Social Security Number
01 Personal Documents 8459 SSA letter confirming error was made-Not Decease
01 Personal Documents 0252 SSA Printout verification only
01 Personal Documents 0248 SSA-2853 Social Security Receipt
01 Personal Documents 5908 SSA-2872 Statement of Death and Burial Services by Funeral Director
01 Personal Documents 8625 SSA-4164 Advance Notification of Representative Payment
01 Personal Documents 5726 SSA-5028 Receipt for Application for a Social Security Card
01 Personal Documents 8624 SSA-787 Physician’s/Medical Officer’s Statement
01 Personal Documents 6254 SSA-795 Statement of Claimant or Other Person
01 Personal Documents 7585 SSA-L676 SSN Card Denial Notice
01 Personal Documents 7425 Statement from Another Person Re Age
01 Personal Documents 6900 Statement from Another Person Re Identity
01 Personal Documents 6902 Statement From Clergy
01 Personal Documents 0096 Statement from Friend Neighbor Relative ID
01 Personal Documents 7418 Statement from Home or health attendant organization program
01 Personal Documents 0192 Statement from Medical Professional Medical Institution/Facility
01 Personal Documents 7308 Statement from Medical Professional verifying pregnancy EDC
01 Personal Documents 0172 Statement from Probation-Parole Officer
01 Personal Documents 7306 Statement from Provider of Health Insurance Premiums
01 Personal Documents 0106 Statement from Rehab V E S I D
01 Personal Documents 0114 Statement from School Authorities
01 Personal Documents 0110 Statement from Social Worker
01 Personal Documents 0118 Statement from Training Institution
01 Personal Documents 5003 Summons
01 Personal Documents 5004 Sworn Statement
01 Personal Documents 8745 TCC316.1 Approval document from Dept of Labor
01 Personal Documents 7373 Three Estimates from clothing or uniform retailer
01 Personal Documents 8685 Unexpired I-688B (EAD) cat 8 CFR 274a.12(a)(19) or A19
01 Personal Documents 8687 Unexpired I-688B (EAD) cat 8 CFR 274a.12(a)(20) or A20
01 Personal Documents 8686 Unexpired I-766 (EAD) cat 8 CFR 274a.12(a)(19) or A19
01 Personal Documents 8688 Unexpired I-766 (EAD) cat 8 CFR 274a.12(a)(20) or A20
01 Personal Documents 0948 US Armed Forces Active Duty Statement
01 Personal Documents 0156 US Immigration Letter Indicating Individual Applied for Asylum
01 Personal Documents 0112 US Passport
01 Personal Documents 7129 US Residence prior to 8/22/96 verified by rent/mortgage records
01 Personal Documents 8093 USA Passport Card
01 Personal Documents 7710 USCIS authoritative document that verifies "S" visa status
01 Personal Documents 7703 USCIS document withholding of deportation or cancellation of removal
01 Personal Documents A230 USCIS Documentation Not Listed Above
01 Personal Documents 9083 USCIS or EOIR document indicating (DACA) had been approved
01 Personal Documents 9086 USCIS or EOIR document indicating pending consideration for (DACA)
01 Personal Documents 7720 USCIS or EOIR indicating Registry Application (I-485) is pending
01 Personal Documents 1822 Vietnamese exit visa or passport stamped "AM1, AM2 or AM3"
01 Personal Documents 0052 Voter's Registration Card
01 Personal Documents 7998 W-116AA Mandatory Appointment Notice to Employment Vendor
01 Personal Documents 7999 W-116CC Mandatory Return Appointment Notice to Employment Vendor
01 Personal Documents 7926 W-116H Employment Appointment Notice
01 Personal Documents 7927 W-116Q POISED Informational
01 Personal Documents 6188 W-127H Authorized Representative Form
01 Personal Documents 6803 W-133D Social Security Verification
01 Personal Documents 6122 W-210X Primary Language Destination Form
01 Personal Documents 6898 W-274E Summer Care Child Enrollment
01 Personal Documents 8039 W-274H Children's Corner Registration Form
01 Personal Documents 7915 W-507HH Notice of Appointment for Disapproved Training Program Review
01 Personal Documents 1686 W-515D Alien Status Verifier
01 Personal Documents 1856 W-560ZZ Application for Child-Only PA Child Case Payments
01 Personal Documents 6130 W-607Q Referral for Photo Signature
01 Personal Documents 6435 W-608T Request For EBT ID Card for Homebound Client
01 Personal Documents 5001 W-608V ID Card Signature Authorization
01 Personal Documents 1016 W-641 Verification of Request for Transportation School Pass
01 Personal Documents 6806 W-680FF Language Questionnaire
01 Personal Documents 7582 W-700E School Verification Letter
01 Personal Documents 8621 W-763A HRA Request for Financial Management
01 Personal Documents 8622 W-763C HRA Client Budget
01 Personal Documents 8623 W-763T HRA Termination of Financial Management Services
01 Personal Documents 8746 W-902F Child Care Worksheet/HASA
01 Personal Documents 7795 W-904KK RTSC- Questionnaire for Minors in Residential Treatment
10 Unscanable Documents A116 40 Qtrs SSA Clearance documentation of work history only seen
10 Unscanable Documents A208 Adoption Subsidy check or copy seen
10 Unscanable Documents A106 Alimony or Support Money Order seen
10 Unscanable Documents A148 Alimony/Support check or copy seen
10 Unscanable Documents 0A86 Bills Submitted and Forwarded
10 Unscanable Documents A223 BOE Match on Address from CED seen
10 Unscanable Documents A152 Child Support check or copy seen
10 Unscanable Documents A102 Child Support Money Order seen
10 Unscanable Documents A110 Client Statement:Have Less Than a 7 Day Oil Supply
10 Unscanable Documents A229 Collateral Call Verifying Foster Care Information
10 Unscanable Documents 0A44 Contact with Friends
10 Unscanable Documents 0A36 Contact with Relatives
10 Unscanable Documents A221 Credit Card with Signature seen
10 Unscanable Documents 0A98 Cross- Machine Clearance Screen seen
10 Unscanable Documents A227 Current Contribution Check seen
10 Unscanable Documents A160 Dividends/Interest check or copy seen
10 Unscanable Documents A225 Home Visit Verifying household composition
10 Unscanable Documents A164 HUD Allowance check or copy seen
10 Unscanable Documents 0A9C Internal Clearance Screen seen
10 Unscanable Documents 6340 M-31a MAP/Other Payroll Match/Income Clearance Program
10 Unscanable Documents 1774 None Available
10 Unscanable Documents A216 Not Applicable
10 Unscanable Documents A168 NYS Disability check or copy seen
10 Unscanable Documents A226 Observation of obvious physical handicap seen
10 Unscanable Documents 0A04 Phone Call to Agency/Source
10 Unscanable Documents 0A12 Phone Call to Corrections Department
10 Unscanable Documents 0A00 Phone Call to Employer
10 Unscanable Documents 0A50 Phone Call to Facility or Listed in W145UU Temporary Housing Chart
10 Unscanable Documents A112 Phone Call to Financial Institution/Lender
10 Unscanable Documents 0A30 Phone Call to Former Employers
10 Unscanable Documents 0A38 Phone Call to Former Landlords
10 Unscanable Documents 0A42 Phone Call to Friends
10 Unscanable Documents 0A54 Phone Call to Medical Facility or M11Q Verified
10 Unscanable Documents 0A16 Phone Call to Medical Records Section of Hospital
10 Unscanable Documents 0A34 Phone Call to Relatives
10 Unscanable Documents 0A46 Phone Call to School Officials
10 Unscanable Documents 0A20 Phone Call to Shelter
10 Unscanable Documents 0A58 Phone Call to Union
10 Unscanable Documents 0A08 Phone Call to VA
10 Unscanable Documents 0A24 Phone Call to Welfare Agency/Program
10 Unscanable Documents 0A62 Processed form W314A
10 Unscanable Documents A214 Quarterly Estimated Tax seen
10 Unscanable Documents A172 Railroad Benefit check or copy seen
10 Unscanable Documents A104 Report to SSA office to correct info on file-NON DOCUMENT
10 Unscanable Documents A176 Retirement check or copy seen
10 Unscanable Documents 0A90 RFI Clearance Screen seen
10 Unscanable Documents A180 Savings Bonds seen
10 Unscanable Documents 0A94 SDX Clearance Screen seen
10 Unscanable Documents A184 Social Security check or copy seen
10 Unscanable Documents 0A74 SS card applied for and denied Non-Document
10 Unscanable Documents A103 SS card Applied for but no Proof submitted-Non-Document
10 Unscanable Documents 0A70 SS card not applied for-Non-Document
10 Unscanable Documents 0A66 SS5 submittted or Referred to SSA to correct demographic info
10 Unscanable Documents 0A9G SSA Verification Pending
10 Unscanable Documents A224 SSI Check or Copy seen
10 Unscanable Documents A212 Stock Certificates seen
10 Unscanable Documents A222 Subsidized Housing Collateral Clearance seen
10 Unscanable Documents A188 Tax Return Check or Copy seen
10 Unscanable Documents A213 Tax Return seen
10 Unscanable Documents A192 UIB check or copy seen
10 Unscanable Documents 0A78 Undocumented Alien
10 Unscanable Documents 0A82 Undomiciled
10 Unscanable Documents A196 Unoin Benefit check or copy seen
10 Unscanable Documents A200 VA check or copy seen
10 Unscanable Documents A220 Verbal Explanation for Job Refusal given unscannable
10 Unscanable Documents A228 W-2 Form seen
10 Unscanable Documents A204 Worker's Compensation check or copy seen
11 Employment Documents 8233 "F401 90 Day Retention Packet
11 Employment Documents 8234 "F501 90 Day Retention with Case Closing Packet
11 Employment Documents 8235 "F601 180 Day Retention Packet
11 Employment Documents 8236 "F701 180 Day Retention w/Wage Gain Packet
11 Employment Documents 6653 "W-560U Request for Information from Employer
11 Employment Documents 5097 Abbreviated Assessment form for PA Recipient in Treatment
11 Employment Documents 6192 ACD 1068 Child Care Accident Report
11 Employment Documents 7965 ACD 1069 Referral To Employer For Employee Income Information
11 Employment Documents 6391 ACD 1513A Notice of Voucher Recert, Authorization and Fee Agreement
11 Employment Documents 5948 ACD Referral to OES or BEGIN
11 Employment Documents 7077 ACD-1069 Referral to Employer for Income Verification
11 Employment Documents 5328 ACD-1082 Vocational Training Recertification
11 Employment Documents 5713 ACD-60 Notice of Admission to Day Care Program
11 Employment Documents 8094 ACS Recert Mail-In Packet
11 Employment Documents 5099 AIS Assignment Information Summary
11 Employment Documents 5101 Appointment Notice
11 Employment Documents 5104 Archive Retrieval Tracking Form
11 Employment Documents 5125 Assignment Information Summary Medical Limitation Alert
11 Employment Documents 5126 Assignment Information SummaryNew YorkCityHumanResources Administration
11 Employment Documents 5127 Attendance Form
11 Employment Documents 5130 Authorization Employment Sanction OES
11 Employment Documents 5131 Authorized Child Care Payments
11 Employment Documents 8944 B2W DTS Supplemental Carfare Request
11 Employment Documents 8732 B2W Vendor 180 Day Bonus with Wage Gain
11 Employment Documents 8731 B2W Vendor 180 Day Retention
11 Employment Documents 8730 B2W Vendor 90 Day Bonus with Case Closing
11 Employment Documents 8729 B2W Vendor 90 Day Retention
11 Employment Documents 8719 B2W Vendor Attendance Verification
11 Employment Documents 8723 B2W Vendor Background Data
11 Employment Documents 8720 B2W Vendor Education & Certificates
11 Employment Documents 8734 B2W Vendor EITC Verification
11 Employment Documents 8724 B2W Vendor Employment Plan or Post Employment
11 Employment Documents 8721 B2W Vendor Employment Verification
11 Employment Documents 8733 B2W Vendor EXCUSED Absence Documentation
11 Employment Documents 8726 B2W Vendor Initial Placement 30days
11 Employment Documents 8727 B2W Vendor Initial Placement Supplement Time limit and Sanctioned
11 Employment Documents 8736 B2W Vendor ITA Approved Voucher
11 Employment Documents 8722 B2W Vendor ITA separate application
11 Employment Documents 8737 B2W Vendor ITA Survey Form
11 Employment Documents 8728 B2W Vendor Post Employment Plan
11 Employment Documents 8725 B2W Vendor Pre Employment Plan
11 Employment Documents 8760 B2W Vendor SNAP Alcohol or Drug Treatment Assessment Packet
11 Employment Documents 8764 B2W Vendor SNAP Assignment Assessment Packet
11 Employment Documents 8761 B2W Vendor SNAP Child Under 18 Assessment Packet
11 Employment Documents 8765 B2W Vendor SNAP Employment Placement Assessment Packet
11 Employment Documents 8758 B2W Vendor SNAP Full Time Student Assessment Packet
11 Employment Documents 8763 B2W Vendor SNAP In-kind Hours Reported Assessment Packet
11 Employment Documents 8756 B2W Vendor SNAP Medical or Mental Assessment Packet
11 Employment Documents 8757 B2W Vendor SNAP Needed in Home Assessment Packet
11 Employment Documents 8759 B2W Vendor SNAP Pregnancy Verification Assessment Packet
11 Employment Documents 8755 B2W Vendor SNAP Refugee Status Package
11 Employment Documents 8766 B2W Vendor SNAP Retention 90 milestone Packet
11 Employment Documents 8762 B2W Vendor SNAP Unemployment Benefits Assessment Packet
11 Employment Documents 8769 B2W Vendor STEP Employment Assessment Packet
11 Employment Documents 8770 B2W Vendor STEP Employment Placement
11 Employment Documents 8768 B2W Vendor STEP OCSE Evaluation
11 Employment Documents 8772 B2W Vendor STEP Retention 180 milestone Packet
11 Employment Documents 8771 B2W Vendor STEP Retention 90 milestone Packet
11 Employment Documents 8738 B2W Vendor Substance Abuse Treatment Verification
11 Employment Documents 8735 B2W Vendor Training ITA or Vocational Attendance Documentation
11 Employment Documents 9109 B2W-FIA Representative Conciliation Documentation
11 Employment Documents 9108 B2W-FIA Representative Employment Plan
11 Employment Documents 8767 B2W  Vendor SNAP Retention 180 milestone Packet
11 Employment Documents 7789 Begin Change of Worksite Request Form
11 Employment Documents 7544 Begin Participant Worksite Evaluation Mid-Point
11 Employment Documents 8219 BFI Employment E-30 Packet
11 Employment Documents 8436 BFI-130 Payroll Inquiry Form
11 Employment Documents 7817 BTW Vendor 180 Day Bonus with Wage Gain
11 Employment Documents 7816 BTW Vendor 180 Day Retention
11 Employment Documents 7815 BTW Vendor 90 Day Bonus with Case Closing
11 Employment Documents 7814 BTW Vendor 90 Day Retention
11 Employment Documents 7547 BTW Vendor Attendance Verification
11 Employment Documents 7819 BTW Vendor EITC Verification
11 Employment Documents 7549 BTW Vendor Employment Verification
11 Employment Documents 7818 BTW Vendor EXCUSED Absence Documentation
11 Employment Documents 7811 BTW Vendor Initial Placement 30days
11 Employment Documents 7812 BTW Vendor Initial Placement Supplement Time limit and Sanctioned
11 Employment Documents 7821 BTW Vendor ITA Approved Voucher
11 Employment Documents 7822 BTW Vendor ITA Survey Form
11 Employment Documents 7813 BTW Vendor Post Employment Plan
11 Employment Documents 7810 BTW Vendor Pre Employment Plan
11 Employment Documents 7823 BTW Vendor Substance Abuse Treatment Verification
11 Employment Documents 7820 BTW Vendor Training ITA or Vocational Attendance Documentation
11 Employment Documents 6190 Business Card or Photocopy of a business card
11 Employment Documents 5137 Care Required by Sick or Disabled Household Member
11 Employment Documents 5834 Carfare Authorization
11 Employment Documents 5139 Carfare Calculation Worksheet For School Training
11 Employment Documents 8812 CAS-500 Mandatory Appointment for Evaluation of Work Activity
11 Employment Documents 5946 Cases Identified for Non-Compliance PRIDE
11 Employment Documents 5142 CEOSC Referral Letter
11 Employment Documents 5143 Certificate of Attendance at a Funeral Service
11 Employment Documents 5944 Checklist for PRIDE
11 Employment Documents 5146 Child Care Advance
11 Employment Documents 5828 Child Care in New York City
11 Employment Documents 5149 Child Care Payment Transmittal Form
11 Employment Documents 5150 Child Care Payment-Request Return
11 Employment Documents 5151 Child Care Payments - Memorandum
11 Employment Documents 5152 Child Care Plan BEGIN
11 Employment Documents 5153 Child Care Provider of Participant Termination Notice to
11 Employment Documents 5159 Childcare Calculation Worksheet for school-training
11 Employment Documents 5163 CIF Client Information Form any kind
11 Employment Documents 5168 Client Rights and Responsibilities
11 Employment Documents 5170 Clients Enrolling in Employment Programs Notice to
11 Employment Documents 5179 Conciliation Notice any kind
11 Employment Documents 5189 Consent for Disclosure of Medical Records from Alcohol and Drugs
11 Employment Documents 5939 Consent to Disclosure of Records
11 Employment Documents 5190 Contract BEGIN
11 Employment Documents 5219 CS-574EE Fact Sheet-Child Care in New York City
11 Employment Documents 7172 Documentation certifying need for licensing/uniform/durable goods fees
11 Employment Documents 7374 Documentation certifying need for work-activity related request
11 Employment Documents 5197 DOH Licensed Child Care Provider Verification
11 Employment Documents 8338 DOH-4469 Financial Status Form
11 Employment Documents 8226 DOH-5017 Verification of Employment
11 Employment Documents 5180 DSS-1230 Conciliation Notification
11 Employment Documents 5980 DSS-1653 Certificate of Employability
11 Employment Documents 7193 DSS-2236 Employment Clearance
11 Employment Documents 6070 DSS-2355 Medical Report Employment
11 Employment Documents 6035 DSS-2643 Foster Home - Certificate to Board Children
11 Employment Documents 5140 DSS-3023 Central Report
11 Employment Documents 6067 DSS-3377 Mandatory Eye Examination Report
11 Employment Documents 5263 DSS-3573 New Recoupment
11 Employment Documents 5255 DSS-3696 Job Search Handbook 15 pages 2 sided
11 Employment Documents 6018 DSS-3707 Employment Verification
11 Employment Documents 5196 DSS-3948 Disability Claim Questionnaire-3 pages
11 Employment Documents 5181 DSS-4230 Conciliation Notification
11 Employment Documents 8017 DSS-Pre Employment Application
11 Employment Documents 8357 EIP/SEI Statement of understanding
11 Employment Documents 5201 Employability Cover Letter Notification of
11 Employment Documents 7372 Employer Letter showing valid offer of employment
11 Employment Documents 7477 Employer's letterhead w phone Hrly rate wkly hrs new first pay date
11 Employment Documents 5415 Employment Appointment Letter
11 Employment Documents 5204 Employment Documentation
11 Employment Documents 5205 Employment History Sheet any kind
11 Employment Documents 8340 Employment Incentives Plus
11 Employment Documents 5206 Employment Plan
11 Employment Documents 7473 Employment Services Packet Begin Internship Program
11 Employment Documents 7474 Employment Services Packet Begin Language Study
11 Employment Documents 7475 Employment Services Packet Begin Work Study
11 Employment Documents 7471 Employment Services Packet Employment Contractor Services
11 Employment Documents 7472 Employment Services Packet Employment Processing Unit EPU
11 Employment Documents 7470 Employment Services Packet Job Opportunity Grant Diversion JOP or GD
11 Employment Documents 7469 Employment Services Packet Training Assessment group TAG or team
11 Employment Documents 7589 Employment Services Packet: Verification of GPA letter COPE Program
11 Employment Documents 8718 Employment Verification Document – 180 days
11 Employment Documents 8716 Employment Verification Document – 30 days
11 Employment Documents 8717 Employment Verification Document – 90 days
11 Employment Documents 5214 EPFT Benefit Data Entry Form OES
11 Employment Documents 5216 Exam for Emp Assess Disability Screening AD Addiction Determination
11 Employment Documents 8083 Excused Hours Documentation
11 Employment Documents 5218 Exemption from WEP
11 Employment Documents 6937 EXP-76A Community Solutions for Trans/MIP Grant Checklist
11 Employment Documents 6938 EXP-76C Metro card Issuance Approval Form
11 Employment Documents 6950 EXP-76E Interim Training Assessment Form
11 Employment Documents 7402 EXP-76G JTP Participant Statement of Understanding
11 Employment Documents 7663 EXP-80R PARKS Job Offer
11 Employment Documents 7938 EXP-84EE Job Fair Notice
11 Employment Documents 8018 EXP-85K Notice of Job Interview
11 Employment Documents 5220 Failure to Cooperate
11 Employment Documents 8482 FIA-1064 Understanding What Will Take Place At My TAG Appointment
11 Employment Documents 8693 FIA-1086 Transition to Back to Work (B2W) Vendor
11 Employment Documents 8694 FIA-1086b Information About Your Literacy Services (BTW)
11 Employment Documents 8754 FIA-1086h Appointment with HRA Staff at Back to Work (B2W)
11 Employment Documents 8790 FIA-1092 Important Notice
11 Employment Documents 8808 FIA-1095a NCA WEP Carfare Log
11 Employment Documents 8870 FIA-1100 Work Schedule For Child Care
11 Employment Documents 8871 FIA-1100a Employer's Verification Work Schedule For Child Care
11 Employment Documents 8457 FSE BTW Employment Declaration Package
11 Employment Documents 8189 FSE Refugee Status Package
11 Employment Documents 8099 FSE Vendor Alcohol or Drug Treatment Assessment Packet
11 Employment Documents 8100 FSE Vendor Child Under 18 Assessment Packet
11 Employment Documents 8105 FSE Vendor Employment Placement Assessment Packet
11 Employment Documents 8103 FSE Vendor Employment Plan Assignment Assessment Packet
11 Employment Documents 8097 FSE Vendor Full Time Student Assessment Packet
11 Employment Documents 8102 FSE Vendor In-kind Hours Reported Assessment Packet
11 Employment Documents 8095 FSE Vendor Medical or Mental Assessment Packet
11 Employment Documents 8096 FSE Vendor Needed in Home Assessment Packet
11 Employment Documents 8108 FSE Vendor Post Retention 180 milestone Packet
11 Employment Documents 8107 FSE Vendor Post Retention 90 milestone Packet
11 Employment Documents 8106 FSE Vendor Post Retention Packet
11 Employment Documents 8104 FSE Vendor Post Retention Plan Assessment Packet
11 Employment Documents 8098 FSE Vendor Pregnancy Verification Assessment Packet
11 Employment Documents 8101 FSE Vendor Unemployment Benefits Assessment Packet
11 Employment Documents 8386 FSE/BTW 100j Package
11 Employment Documents 5232 HRA Medical Examination
11 Employment Documents 5234 HRA Pride 2000 Client Record
11 Employment Documents 5236 Human Resources Administration Employment Questionnaire
11 Employment Documents 5238 Increased WEP Hours and Child Care Requirements Notification of
11 Employment Documents 5239 Individual Education Program
11 Employment Documents 8063 Individual Plan of Employment
11 Employment Documents 5240 Information Request Letter
11 Employment Documents 5241 Initial Child Care Provider Letter
11 Employment Documents 5242 Inquiry Form
11 Employment Documents 5246 Internal Questionnaire
11 Employment Documents 5247 Internship Referral Letter
11 Employment Documents 5832 Job Center Routing Form
11 Employment Documents 5256 Licensed Child Care Provider Liaison Unit Inquiry Form
11 Employment Documents 5257 Licensed Child Care Provider Unit Form
11 Employment Documents 5258 Licensed Day Care Provider of Termination Notice to
11 Employment Documents 6218 List of addresses and or phone numbers
11 Employment Documents 5266 M-160 Original or Copy of Checks Request for
11 Employment Documents 5267 M-160J Request for Original or Copy of Checks
11 Employment Documents 7962 M-183b Wage and Health Benefits Report
11 Employment Documents 6143 M-22b Request for information on child 16 years of age and over
11 Employment Documents 6972 M-327a Self-Sufficiency case progress review
11 Employment Documents 7231 M-528J Child Care Appointment Notice
11 Employment Documents 5165 M-623a Client of Housing Services Subsidy Notice to
11 Employment Documents 7020 M-696a Plan of Self Support
11 Employment Documents 7021 M-696b Plan of Self Support Agreement for Medicaid
11 Employment Documents 7022 M-696c Plan of Self-Support Agreement for Public Assistance
11 Employment Documents 5209 M-6h Employment Related Case Closing or Reduction
11 Employment Documents 8742 M-75q B2W Special Shelter Initiative H Voluntary Assignment
11 Employment Documents 5260 Master List of Training Programs OES Resource Development
11 Employment Documents 5261 Medical Assessment Request for
11 Employment Documents 5262 Miscellaneous Employment Documentation
11 Employment Documents 6076 Notice of Appeal for Predetermination of Eligibility for Day Care
11 Employment Documents 6083 Notice of Eligibility and Day Care Service & Fee Agreement
11 Employment Documents 6084 Notice of Eligibility Authorization for Voucher for Day Care Service
11 Employment Documents 6088 Notice of Intent to Discontinue Day Care
11 Employment Documents 6089 Notice of Intent to Discontinue Day Care
11 Employment Documents 8358 Notice of Termination or Rollover- EIP/SEI
11 Employment Documents 8921 NYCWAY HASA/ACM Referral Packet
11 Employment Documents 1262 OES-3A Job Notice
11 Employment Documents 5970 OES-4 Begin Work Study Attendance Policy Agreement
11 Employment Documents 5138 OES-4N Career Planning Training Letter
11 Employment Documents 5271 OES-4Q Participant Referral to Job Site
11 Employment Documents 5292 OES-4T Referral Outcome Report BEGIN
11 Employment Documents 5225 OES-4X HR Job Search PA & FS Job Search Participant Rights and Resp
11 Employment Documents 5268 Parental Choice Declaration
11 Employment Documents 5272 Participant's Rights and Responsibilities
11 Employment Documents 5273 Participation Agreement
11 Employment Documents 5275 Participation Program Summary BEGIN
11 Employment Documents 5276 Payment Inquiry Review
11 Employment Documents 5277 Payment Verification Form
11 Employment Documents 8525 POISED PACKET
11 Employment Documents 5938 PRIDE 2000 Referral Letter or PRIDE Assessment Referral Letter
11 Employment Documents 5940 PRIDE Client Record
11 Employment Documents 5282 Program Participant Statement of Understanding-Training & Employment Assistance
11 Employment Documents 5284 Provider Requst Conclusion
11 Employment Documents 5285 Providers information Not Found at BEGIN Letter to
11 Employment Documents 5286 Quick Service
11 Employment Documents 5288 Quick Service Prescreening Form
11 Employment Documents 5289 Recertification Worksheet
11 Employment Documents 8392 Recruiting / Referral - Employment Service
11 Employment Documents 5291 Recurring Allowance Authorization Form
11 Employment Documents 5293 Referral to ACD for Day Care Services OES
11 Employment Documents 5920 Referral to Employer for Employee Information
11 Employment Documents 5294 Referral to Employment Center
11 Employment Documents 5297 Referral to Office of Employment Services-Job Readiness
11 Employment Documents 5303 Sanction and Transmittal BEGIN
11 Employment Documents 5304 Sanction TAD Transmittal-BEGIN
11 Employment Documents 5309 Single Issue Transmittal
11 Employment Documents 8740 SNAP B2W Employment Declaration Package
11 Employment Documents 8739 SNAP/B2W 100j Package
11 Employment Documents 5311 Student Information Release Form
11 Employment Documents 8341 Subsidized Employment Initiative
11 Employment Documents 5312 Substance Abuse Client History
11 Employment Documents 5313 Summary of Proceedings
11 Employment Documents 5314 Suspension letter
11 Employment Documents 8249 TEAM TAG Training Verification Document Packet
11 Employment Documents 5315 Temporarily Unemployable Notice of
11 Employment Documents 5316 Testing Center Referral Letter
11 Employment Documents 8082 Timekeeping Sheets
11 Employment Documents 5317 Training & Employment Assistance Program Participant Statement of Understanding
11 Employment Documents 5322 TRE Reconsideration Request
11 Employment Documents 5323 Tre Termination Letter-Employment
11 Employment Documents 5324 Tre Termination Letter-Non Compliance Notification
11 Employment Documents 7422 UIB Monetary Determination Letters
11 Employment Documents 7478 UIB Notice of Determination of Ineligibility or Disqualification
11 Employment Documents 5326 Up-Front Verification/Initial Case Report
11 Employment Documents 8151 Verification of Absence from Program-PCS
11 Employment Documents 5327 Verification of Student Work Schedule
11 Employment Documents 5329 Voluntary Participation Agreement
11 Employment Documents 7993 W-100C Barrier to Employment Form
11 Employment Documents 7994 W-100E De-assignment Letter
11 Employment Documents 7995 W-100F Food Stamp Employment and Training Employability Assessment
11 Employment Documents 7996 W-100H Loss of Employment Form
11 Employment Documents 7997 W-116BB Assignment Letter
11 Employment Documents 6666 W-116G Notice of Job Placement
11 Employment Documents 8210 W-116HH Employment Verification Form
11 Employment Documents 7233 W-116P Mandatory Job Search Business Link Appointment
11 Employment Documents 5227 W-132T Households with Authorized Representatives, Notice to
11 Employment Documents 5208 W-167C Employment Referral
11 Employment Documents 6094 W-2-114 Notice of No Carfare
11 Employment Documents 6111 W-2-17 Office of Employment Services OES Child
11 Employment Documents 5192 W-2-173A Declaration of Employment
11 Employment Documents 5299 W-2-229G Reminder Letter BEGIN
11 Employment Documents 5231 W-2-244 HRA Letterhead-Family Support Administration MAP
11 Employment Documents 5233 W-218 HRA Memo
11 Employment Documents 5176 W-25 C Conciliation History Sheet
11 Employment Documents 5186 W-25F Conference History Sheet
11 Employment Documents 5187 W-26 Conference History Sheet
11 Employment Documents 6039 W-273D How to fill out the Child Care Provider Form CCPF
11 Employment Documents 6193 W-273J Child Care Provider Contact List
11 Employment Documents 6055 W-273K Initial Child Care Payment Authorization Form
11 Employment Documents 7936 W-274CC Child Care Enrollment Call-In Notice
11 Employment Documents 7612 W-274X Securing a Child Care Provider Prior to Recertification
11 Employment Documents 5193 W-278 Declaration of Employment
11 Employment Documents 6000 W-28A Continuation Sheet
11 Employment Documents 8483 W-300 Referral to Wellness-Employment WeCare for a Clinical Review
11 Employment Documents 7968 W-331Q Disability Services Program Return Appointment
11 Employment Documents 7486 W-331W Disability Services Prgrm Mandatory Assessment Interview
11 Employment Documents 7937 W-333G Child Care Enrollment Call-In Notice
11 Employment Documents 6144 W-344 Request for Leave
11 Employment Documents 6169 W-347 Weekly Time Control
11 Employment Documents 6173 W-364 Work Experience Program WEP Referral to Worksite
11 Employment Documents 6538 W-364A New Start WEP Determination Form
11 Employment Documents 5318 W-456U-A Training and Employment Assistant Program Summary Plan
11 Employment Documents 7235 W-500X Time Limits Eligib Rev Appoint Notice for Sanction HH
11 Employment Documents 7236 W-500Y Mandatory POISED Assessment Appointment
11 Employment Documents 8741 W-502 Referral to Back 2 Work B2W Vendor
11 Employment Documents 6955 W-507 Mandatory Training Assessment Group Appointment
11 Employment Documents 7966 W-516E Real Property Tax Credit Notice
11 Employment Documents 7967 W-516G New York State Nutrition Incentive Program RPTCN
11 Employment Documents 5110 W-521D Assignment Information Summary ADC Referral
11 Employment Documents 5955 W-532K Agreement to Comply with Employment Program Requirements
11 Employment Documents 7239 W-533G WeCare Nonmedical Referral for Mandatory Services
11 Employment Documents 5279 W-537D Physician's Assessment of Client's Employability
11 Employment Documents 6016 W-541B Employment Record
11 Employment Documents 6131 W-548A Referral to ACD for Day Care Services
11 Employment Documents 5336 W-550R-M Work Compliance Referral
11 Employment Documents 6104 W-555C Notification of Report of Child Abuse or Maltreatment
11 Employment Documents 6108 W-559B NYC WAY
11 Employment Documents 6393 W-560J Work Related Benefits Program Monthly Voucher
11 Employment Documents 5169 W-564 Client's Employability
11 Employment Documents 5278 W-565B Personal Questionnaire
11 Employment Documents 5338 W-565C Work Experience Program Regulations
11 Employment Documents 5305 W-568 Scheduled for an Appointment at the WEP
11 Employment Documents 5166 W-568B Client Request for Review of Employability Status
11 Employment Documents 5167 W-568E Client Request for Review of Employability Status.Train
11 Employment Documents 6139 W-568K Request for Exemption - Review of Employability Status
11 Employment Documents 5129 W-568Q Attendance Verification Letter
11 Employment Documents 5245 W-568U Intent to Change Continue Ben PA-FS-MA Cov and Serv Notice of
11 Employment Documents 5178 W-569C Conciliation Notice
11 Employment Documents 5995 W-570 Component Enrollment
11 Employment Documents 5957 W-570A Allowance Worksheet
11 Employment Documents 5188 W-570L Confirmation of New Appointment
11 Employment Documents 5171 W-570P Clients Enrolling in School and Training-Prog Notice to
11 Employment Documents 6117 W-570T Participant Attendance Card
11 Employment Documents 5194 W-570Y Degree Granting College Tre-Application
11 Employment Documents 5270 W-572E Participant Change of Status Report
11 Employment Documents 5339 W-572N Work Experience Program Regulations and Attendance Policy
11 Employment Documents 5243 W-573 Intake Referral BEGIN
11 Employment Documents 5343 W-573BB Work Study Referral Letter
11 Employment Documents 5202 W-573D Employability Development Plan BEGIN
11 Employment Documents 5249 W-573F Job Club Evaluation BEGIN
11 Employment Documents 6057 W-573Q Intake Re-evaluation form BEGIN
11 Employment Documents 5124 W-573R Assignment Information Summary BEGIN Work Study Program
11 Employment Documents 6168 W-573RR Verification of Student Work Schedule
11 Employment Documents 6110 W-574D Office of Employment Services OES
11 Employment Documents 5161 W-574FF Proof of ID For Your Child Care Provider or Babysitter
11 Employment Documents 6174 W-574HH Work Study Referral Letter
11 Employment Documents 5164 W-574Q Client Information Form NYC WAY
11 Employment Documents 5162 W-574XX CIF Client Information Form
11 Employment Documents 5133 W-576-N Authorized OES Case Reopening Action
11 Employment Documents 5298 W-576J Referral to Resource Development
11 Employment Documents 5213 W-576K Employment Notification of
11 Employment Documents 5203 W-576N Employability Plan Background Info BEGIN
11 Employment Documents 5244 W-576Q Intent to Change PA Grant FS-MA for Non-Compl w Empt-Rel Reqs
11 Employment Documents 5217 W-576U Excuse Form For WEP Participants Arranging Child Care
11 Employment Documents 5109 W-577 Assignment Information Summary
11 Employment Documents 5123 W-578UU Assignment Information Summary Standard OES
11 Employment Documents 6257 W-580AA To be Completed by Individual Providing Chid Care
11 Employment Documents 5222 W-582A Family Care Assessment
11 Employment Documents 5207 W-584A Employment Plan NYC WAY BEGIN
11 Employment Documents 7237 W-584K Mandatory Appointment for Evaluation of Work Activity
11 Employment Documents 7238 W-584M Reevaluation of Employability Status Appointment
11 Employment Documents 6942 W-592G Employment and Wage Verification Form
11 Employment Documents 7035 W-592Q Employment and Wage Verification Form
11 Employment Documents 9103 W-592W Employment and Wage Verification
11 Employment Documents 6116 W-667A Parent's Checklist for Group Day Care
11 Employment Documents 5147 W-667C Child Care Confirmation Form
11 Employment Documents 5148 W-667C Lic Child Care Confirmation Form Lic Reg Child Care
11 Employment Documents 6132 W-680CC Referral to FIA Employment
11 Employment Documents 5989 W-687C Child Care Single Issuance Authorization
11 Employment Documents 5693 W-700D FIA School or Training Enrollment Letter
11 Employment Documents 5976 W-719G Carfare Authorization
11 Employment Documents 5945 Waiver Evaluation/Services Referral PRIDE
11 Employment Documents 8150 WEM Attendance Documents Package-Attendance Docs-Discretionary Form
11 Employment Documents 8153 WEM Employment Verification Documents-Paystub-Job Letter-FIA3a-PCS
11 Employment Documents 8154 WEM Medical Exemption-Documents Claiming Medical Exemption
11 Employment Documents 8149 WEM School/Training Package-School Verifications-PCS Form
11 Employment Documents 8152 WEM Unemployment Insurance Determinations-UIB Documents-PCS
11 Employment Documents 5330 WEP Assignment Worksheet for College TANF Clients
11 Employment Documents 8155 WEP Incidents/Documentations-PCS
11 Employment Documents 6179 WEP or AVU Roster
11 Employment Documents 5331 WEP Participant Termination from Assignment Report OES
11 Employment Documents 5332 WEP Participant's Timesheet
11 Employment Documents 5333 Withdrawal Notice of
11 Employment Documents 5342 Work Accountability and You WAY Activity Inquiry
11 Employment Documents 5335 Work Assignment Sheet-College TANF Clients BA
11 Employment Documents 5337 Work Experience Program Participant Termination From OES
11 Employment Documents 5340 Work Study Referral Letter
11 Employment Documents 5341 Work Study Transfer Form BEGIN
11 Employment Documents 5223 Year Final Semester Request for Exempt From OES Mandated Activities
12 Food Stamps 8041 "W-119D Eligibility Factors and Suggested Documention Guide
12 Food Stamps 6106 2002C-Map
12 Food Stamps 5349 Application Worksheet
12 Food Stamps 5353 Budget Entry Supervisor Summary
12 Food Stamps 5354 Case Composition
12 Food Stamps 5355 Case Summary
12 Food Stamps 7192 CCF1 Claims Control Form
12 Food Stamps 5356 Change Group History
12 Food Stamps 5357 Check Copy-US Treasury
12 Food Stamps 5358 Claimant Correspondence
12 Food Stamps 5359 Clearance Report
12 Food Stamps 5410 CNS-Supervisory Review Report
12 Food Stamps 5361 Continuing Eligibility Determination Worksheet for NPA
12 Food Stamps 6635 DFS-37
12 Food Stamps 5364 Documentation Request
12 Food Stamps 8701 DSNAP Packet
12 Food Stamps 5961 DSS-179-2 Application for Food Stamps - Part 2
12 Food Stamps 5370 DSS-3035 FS Appt for SSO Recipients and Group Living Residents
12 Food Stamps 5374 DSS-3151 Food Stamp Change Report Form 2 pages 2 sided
12 Food Stamps 5379 DSS-3574 Food Stamp Single Issuance Authorization Form
12 Food Stamps 5352 DSS-3577 Batch Transmittal
12 Food Stamps 5385 DSS-3620 Notice of Intent to Change FS Benefits
12 Food Stamps 5384 DSS-3621 Notice of Intent to Change FS Benefits Adequate Only
12 Food Stamps 7093 DSS-4053 Food Stamp Repayment Agreement
12 Food Stamps 6114 DSS-4310 PA and Food Stamp Document
12 Food Stamps 5412 DSS-4482/30 Transmittal of Fair Hearing Decision to DSS Agency
12 Food Stamps 6970 DSS-4753 Food Stamps-request for contact or missed interview
12 Food Stamps 6010 EBT Balance Inquiry
12 Food Stamps 6637 EBT-32
12 Food Stamps 5366 Eligibility Determination Worksheet
12 Food Stamps 7799 EXP-84K Letter to Food Stamp Enrollees
12 Food Stamps 5363 F-15 Discrepant Eligibility Information Tracking Form
12 Food Stamps 9053 FIA-1021o You May be Eligible to Receive SNAP Benefits
12 Food Stamps 8518 FIA-1062 Important Notice to Food Stamp Participants
12 Food Stamps 8519 FIA-1063 SNAP Employment and Training/Enrollment/Consent Form
12 Food Stamps 8700 FIA-1088a Denial of your Request for a SNAP Benefit Supplement
12 Food Stamps 8774 FIA-1088b Receipt for (DSNAP) Application
12 Food Stamps 8775 FIA-1088d Questions and Answers on (DSNAP)
12 Food Stamps 8773 FIA-1090 DSNAP Information Document
12 Food Stamps 5373 Food Stamp Center 44 Flushing Recertification Questionnaire
12 Food Stamps 5375 Food Stamp Documentation any kind
12 Food Stamps 5376 Food Stamp Eligibility Decision for Legal Resident Non-Citizens Notice of
12 Food Stamps 5377 Food Stamp Issuance
12 Food Stamps 8324 Food Stamp Online Application Summary Access NYC
12 Food Stamps 8191 Food Stamp Online Application Summary myBenefits
12 Food Stamps 7870 Food Stamp Telephone Recertification Interview Guide
12 Food Stamps 5380 Food Stamps Budget Calculation
12 Food Stamps 6581 Food Stamps Pre-Screening Form
12 Food Stamps 5381 Help With Expenses Request Proof of
12 Food Stamps 6584 History Sheet - FS Overpayment Claim History Sheet
12 Food Stamps 5382 Human Resource SDX Extract NYC
12 Food Stamps 5386 International Money Order
12 Food Stamps 6939 LDSS-2291 Request For Replace Food Purchased With FS Benefits
12 Food Stamps 5345 LDSS-3152 Action Taken on Your Food Stamp Case
12 Food Stamps 6957 LDSS-3513 FS Recoupment Data Entry Form-WMS
12 Food Stamps 7514 LDSS-3938 FS Application Expedited Processing Summary Sheet
12 Food Stamps 6922 LDSS-4826 Food Stamp Benefits Application
12 Food Stamps 7240 LDSS-4836 NYSNIP Food Stamp Benefits Interim Report (NYC)
12 Food Stamps 7143 LDSS-4841 NYSNIP Food Stamp Case Information Collection Sheet
12 Food Stamps 8110 LDSS-4942 Food Stamp Program Authorized Representative Request Form
12 Food Stamps 8696 LDSS-4988 Applic For Disaster Supplemental Nutrition Assist Program
12 Food Stamps 8695 LDSS-4989 Disaster Supplemental Nutrition Assistance Program Case
12 Food Stamps 6760 M-321a Food Stamp Recertification
12 Food Stamps 6759 M-321e Food Stamp Recertification Packets
12 Food Stamps 8014 M-328c Notice to Participant Restriction of Renr Payment
12 Food Stamps 5344 M-4d Action Taken in Compliance with a Fair Hearing Decision
12 Food Stamps 7869 Non-Response to Telelphone Recertification Notice
12 Food Stamps 5394 NPA Food Stamp Pre-Screening Form
12 Food Stamps 8092 PA-FS Grant Profile Report
12 Food Stamps 5396 Payee of Rent not Resident Letter From
12 Food Stamps 8355 POS Budget Letter for NCA Food Stamp Case
12 Food Stamps 5397 Prescription Slips
12 Food Stamps 5398 Recoupment Menu
12 Food Stamps 5400 Rent Change Notice
12 Food Stamps 5401 Retroactive Unit Report of Action Taken on a Fair Hearing Decision
12 Food Stamps 5402 Roommate Letter
12 Food Stamps 5405 SDX Inquiry
12 Food Stamps 6621 Social Security Report or Individual Sheet mixed Food Stamps H-H 1B
12 Food Stamps 6252 SSA-4233 SSA Transmittal for Food Stamp Application
12 Food Stamps 5409 Sublease Agreement Renewal
12 Food Stamps 5411 Supplemental Security Income Change in Payment Notice of
12 Food Stamps 7195 Treasury Offset Program TOP Client Appeal Review Worksheet 4 pages
12 Food Stamps 8047 W-100J Food Stamp Employment Declaration
12 Food Stamps 8048 W-100K Claim of In-Kind Work
12 Food Stamps 6665 W-102C FA or MA Recertification Form
12 Food Stamps 5413 W-112H Wage Reporting and Unemployment Insurance Clearance
12 Food Stamps 6398 W-119A Food Stamp Application Control Card
12 Food Stamps 7568 W-120 Food Stamp Benefits Application Signature Form
12 Food Stamps 5365 W-120D Documents Received Required Notice of
12 Food Stamps 6744 W-120D Notice of Documentation Required
12 Food Stamps 6399 W-120K HRA Income Support Programs Food Stamp Program
12 Food Stamps 6634 W-122A Monthly Food Stamps Worksheet
12 Food Stamps 5389 W-122AA Monthly Food Stamp Worksheet
12 Food Stamps 5369 W-127C Food Stamp Application Statement 2 sheets 4 pages
12 Food Stamps 5406 W-127NP Important Notice to Food Stamp Applicants Participants
12 Food Stamps 7777 W-129A FS Eligibility Interview Telephone Appointment Notice
12 Food Stamps 7778 W-129B FS Benefits Application Attestation Signature Form
12 Food Stamps 5371 W-129BB-CC Food Stamp Authorization Form - Mail
12 Food Stamps 5391 W-129CC NPA Food Stamp Authorization Form-Mail
12 Food Stamps 6159 W-129E Submission of information to Food Stamp Program
12 Food Stamps 6818 W-129RR Important Notice of Recertification Appointment
12 Food Stamps 7066 W-129U Food Stamp Budget Worksheet
12 Food Stamps 6031 W-129Y Food Stamp Authorization Form - in person
12 Food Stamps 7678 W-130G Action Taken on Replacement of FS Stolen from EBT
12 Food Stamps 5393 W-130G NPA Food Stamp Authorization Form
12 Food Stamps 6034 W-131B Food Stamp Notice of Expiration
12 Food Stamps 6107 W-132AA NPA FS History Employment Recor -12 mos prior to application
12 Food Stamps 5387 W-132B Ledger Record of FS Authorizations
12 Food Stamps 7080 W-132R ABAWD Tracking Log
12 Food Stamps 5982 W-132W Change Report Form for food stamp program 4 pgs
12 Food Stamps 5378 W-132X Food Stamp Recertification Worksheet 2 pages 2 sided
12 Food Stamps 6526 W-133BB Important Food Stamp Notice
12 Food Stamps 5360 W-133D Clearance Report on SSI Food Stamp Cases
12 Food Stamps 5346 W-133J Additional Information to Complete FS Application, Rqst
12 Food Stamps 5408 W-133N SSI Office Case Summary
12 Food Stamps 5404 W-133P Routing Form
12 Food Stamps 5368 W-134X Evaluation of FS Eligibility Decision by Legal Resident
12 Food Stamps 6636 W-138NN NPA-Computer Match Worksheet
12 Food Stamps 5350 W-138PP Appointment for Recertification Interview Notice of
12 Food Stamps 5348 W-138XX All Food Stamp Recipients Notice of
12 Food Stamps 5351 W-140A Attention Brooklyn and Queens Food Stamp Clients
12 Food Stamps 6314 W-140CC New Claims Prescreening Form
12 Food Stamps 8405 W-140EE Report of Claims Determination Transmittal
12 Food Stamps 6633 W-140GG Letter of Employer
12 Food Stamps 5372 W-140H FS Case Transferred to Following Center
12 Food Stamps 7909 W-140VV Food Stamp Recertification Notice F61 and F63
12 Food Stamps 7910 W-25M Residential Treatment Center Eligibility Recertification F61
12 Food Stamps 5392 W-515E New Eligibility Rules for Legal Aliens
12 Food Stamps 6400 W-515H Food Stamp Penalty Warning
12 Food Stamps 8046 W-532E Participant Request for Review of Employability Status
12 Food Stamps 8535 W-69-202 Self Address Return Envelope
12 Food Stamps 7871 W-901F Incomplete SNAP Recertification Form
12 Food Stamps 8804 W-901K Incomplete SNAP Application Form
12 Food Stamps 8228 W-908F Rescheduled Food Stamp Telephone Recertification Interview
12 Food Stamps 5414 Waiver of Authorized Representative
12 Food Stamps 7564 WINR0811 Newborn-Unborn FS Activation Report One page or one case only
12 Food Stamps 6172 WINRO153 Food Stamp Budget Calculation
13 Medicaid 8216 "HC-Service Section Prior 2004 Archive
13 Medicaid 7836 "MAP-101B Acknowledgment for Application
13 Medicaid 7835 "MAP-900 Request For Additional Information
13 Medicaid 7366 1HHJ Job Ticket or Control Form CASA
13 Medicaid 8529 2009 Archive CAH Service Packet
13 Medicaid 8532 2009 Archive OOT Service Packet
13 Medicaid 8530 2010 Archive CAH Service Packet
13 Medicaid 8533 2010 Archive OOT Service Packet
13 Medicaid 7576 20CONTOASAS Restricted Recipient Activity Packet
13 Medicaid 6868 423B Referral to Riverview Center
13 Medicaid 7574 888 RRP Notice of Intent to Restrict Medicaid
13 Medicaid 8158 Access NYC Online Renewal Summary
13 Medicaid 5749 Acknowledgement of Fair Hearing Request
13 Medicaid 5748 Action Taken on Application
13 Medicaid 5743 ADC-U Screening Checklist
13 Medicaid 8579 Additional Core DVE (16DI)
13 Medicaid 8580 Additional IPE (16DC, 16PI)
13 Medicaid 8582 Additional Supp DVE (16SI)
13 Medicaid 8666 Affidavit Notice (any kind)
13 Medicaid 6449 Affiliation Referral Form-3000 Series
13 Medicaid 5825 Allowance Worksheet
13 Medicaid 6450 ALPS Medicaid Information and Problem Check List
13 Medicaid 5761 Applicant or Recipient Request for Conference Review
13 Medicaid 5780 Application for Recertification for Information of Income and Resource
13 Medicaid 5763 Application Review Checklist
13 Medicaid 5808 Application Worker Daily Log
13 Medicaid 8692 Approved Medicaid Prior Authorization – Out of State SNF Placement
13 Medicaid 6451 Assisted Living Program Assessment Review Form
13 Medicaid 6452 Assisted Living Program Interim Assessment
13 Medicaid 7940 Attestation for Medicaid Applications Rikers
13 Medicaid 7957 Before Signing Up for Health Insurance Plan You Should Know
13 Medicaid 9114 BFI-222 Jurisdictional Dispute
13 Medicaid 8469 BFI-25C Report of Investigation (MA)
13 Medicaid 8531 CAH Service Packet
13 Medicaid 8564 Cardiology Lab
13 Medicaid 8339 CAS-200 Authorization for Health Information
13 Medicaid 8803 CAS-201 Authorization for Medicaid Record
13 Medicaid 8943 Case Notes CHP/FHP/MA
13 Medicaid 5777 Case Record Request
13 Medicaid 5764 Case Submission Sheet
13 Medicaid 5845 Certification of Parental Failure to Cooperate in Protective Services
13 Medicaid 6457 CHHA Conversion Alert Notice-3000 Series
13 Medicaid 8406 Child/Teen Health Program Reply Form
13 Medicaid 6424 Childhood Disability Evaluation Form Medicaid Program
13 Medicaid 5620 Client Checklist for Medical Assistance
13 Medicaid 6458 Client Task Sheet-Medical Review Team MRT Plan of Care-3000 Series
13 Medicaid 6459 CMP Reviewer Letter
13 Medicaid 6196 Community Eligibility Division-Data Entry Error Return Control
13 Medicaid 5657 Community or Spouse Concerning Income be provided by Institutional
13 Medicaid 8583 Comprehensive Service Plan Updated
13 Medicaid 5623 Confidential Information Intended Solely For Professional Use Redisclosure Prohi
13 Medicaid 5621 Confirmation of Identity for Medicaid Applicants
13 Medicaid 5756 Consent for Bank Clearances
13 Medicaid 7941 Consent to Release and Obtain Information for Health Care
13 Medicaid 6460 Consumer Directed Personal Assistance Program Appl Info & Instructions
13 Medicaid 5685 Consumer Guide to completing the Mail Recertification in Seven Steps
13 Medicaid 5833 Continued Medicaid Coverage for Newborn Babies Recertification Statem
13 Medicaid 8874 Court Document (MICSA only)
13 Medicaid 8192 Credible Maintenance Statement
13 Medicaid 5760 CRT Search
13 Medicaid 5733 CS-19 Temporary Medicaid Authorization
13 Medicaid 5706 CSC Job Referral Inquiry - Notice and Proof of Claim for Disability
13 Medicaid 6461 Dear Doctor Letter
13 Medicaid 5794 Decision of Medical Assistance Application
13 Medicaid 5812 Decision on Applicant or Benefit for Medicare Buy-in Pgrm Notice of M
13 Medicaid 6466 Decision to Auth Reauth Deny Discont. PERS PERS Emerg Respns Svc
13 Medicaid 8565 Dermatology Lab
13 Medicaid 7958 Determining Self Employment Income with Tax Returns for Medicaid-FEAU
13 Medicaid 8786 DFTA Case Management Application form for MA Home Care
13 Medicaid 6845 DFY 2507 Household Economic Impact-Confidential
13 Medicaid 8526 Dialysis Notice (of any kind)
13 Medicaid 5855 Division of Hospital Eligibility - Notice of Medicaid Acceptance - MA
13 Medicaid 7508 DOH Office of MA Management DATA MART RRP
13 Medicaid 6626 DOH 4133 Growing Up Healthy
13 Medicaid 6627 DOH 4133A Growing Up Healthy
13 Medicaid 5535 DOH-1260 Local Medical Director Deter/Decision of Medical Eligibility
13 Medicaid 5880 DOH-1565 Medical Insurance Determination
13 Medicaid 7292 DOH-2557 NYS DOH Auth Release of Confidential HIV Related Info
13 Medicaid 5636 DOH-3 Utilization Review
13 Medicaid 7029 DOH-3608 HIV Uninsured Care Programs
13 Medicaid 7163 DOH-3758 Missing information Letter Client to Return within 24 hrs
13 Medicaid 7981 DOH-4097 Medicaid Managed Care and Family Health Plus Enrollment Form
13 Medicaid 6746 DOH-4220 Health Insurance and Nutrition App For Medical Assistance
13 Medicaid 7838 DOH-4282 Application for Family Plan Benefit Program
13 Medicaid 8706 DOH-4289 Notice of Decision On Your Medical Assistance Application
13 Medicaid 9046 DOH-4312 Notice of Decision to Approve or Deny Enrollment
13 Medicaid 9047 DOH-4314 Notice of Decision Discontinue
13 Medicaid 7545 DOH-4325 Notice of Intent to Authorize/Reauthorize or Deny
13 Medicaid 7476 DOH-4328 Medicare Savings Program Application
13 Medicaid 8777 DOH-4337 Physician Confirmation Form
13 Medicaid 8470 DOH-4419 Day Care Home Enrollment Form
13 Medicaid 8190 DOH-4443 NYS-DOH Financial Maintenance
13 Medicaid 8256 DOH-4471 FHP Certification Treatment for Emergency Medical Condition
13 Medicaid 8257 DOH-4495A Access NY Supplement A
13 Medicaid 8167 DOH-4496 Medicare Savings Program Request for Information Form
13 Medicaid 8170 DOH-4496 NYS Medicare Savings Program Request For Information
13 Medicaid 8779 DOH-5027 PARR Mental Health Evaluation Report
13 Medicaid 9073 DOH-5079 Paper Application for NYS of Health
13 Medicaid 8784 DOH-51 Supplemental Report of Given Name
13 Medicaid 5865 DOH-694 Hospital and Community-Patient Review Instrument
13 Medicaid 6472 DOH-695-NYS Dept of Health Screen-Complete after reviewing PRI
13 Medicaid 5917 DOH-799 WIC Medical Referral Form
13 Medicaid 8788 DOHS Warrant for Arrest of Alien
13 Medicaid 8497 Draft Supplement Needs Trust
13 Medicaid 7880 DSP Medical Documentation
13 Medicaid 7881 DSP Releases
13 Medicaid 7879 DSP-DRD Medicaid Documents
13 Medicaid 8010 DSP-DRD-0001 MA Application Package
13 Medicaid 6402 DSS-1003 General Basic Medical Exam Record
13 Medicaid 5806 DSS-1151 and DSS-1151-1 Instructions for Completing
13 Medicaid 5444 DSS-1151 Disability Interview
13 Medicaid 5651 DSS-1451 Disability Interview
13 Medicaid 5491 DSS-1963EL Quality Control Results
13 Medicaid 5449 DSS-2642 Documentation Requirements
13 Medicaid 6160 DSS-2831A - MAP-2079K Temporary Medicaid Authorization
13 Medicaid 5518 DSS-2831A Temporary Medicaid Authorization
13 Medicaid 6404 DSS-3074 NYS Medical Assistance Program Status of Bed Reservation
13 Medicaid 7206 DSS-3122 Medical Evaluation Resident Medical history
13 Medicaid 5725 DSS-3133 Provider or Recipient Letter
13 Medicaid 7165 DSS-3139 DOH Off of Hlth Systems Management - Home Assess Abstract
13 Medicaid 5538 DSS-3183 Financial Obligation of Recip Toward Medical Expenses
13 Medicaid 5655 DSS-3252 Verification of Legal Blindness
13 Medicaid 7166 DSS-3394 Long Term Health Care Pro Waived Services Prior Author
13 Medicaid 6405 DSS-3451 Comm for the Blind or Visually Handicapped Medical Eye Report
13 Medicaid 5539 DSS-3477 Principal Provider Data Input Form
13 Medicaid 5478 DSS-3517-15 Medical Assistance Coverage Data Entry Form
13 Medicaid 5428 DSS-3570 Certification Guide
13 Medicaid 5918 DSS-3576 WMS or NYC-MA Authorization Document
13 Medicaid 5470 DSS-3585 MBL Budget Record Form
13 Medicaid 7773 DSS-3602B APS ASSESSMENT OR SERVICES PLAN
13 Medicaid 5735 DSS-3652 Transaction Cancellation Data Entry Form
13 Medicaid 5869 DSS-3816 Individual Information Data Entry
13 Medicaid 5482 DSS-3817 Mental Residual Functional Capacity Assessment
13 Medicaid 5490 DSS-3818 Psychiatric Review Technique
13 Medicaid 5724 DSS-3833 Prenatal Care Referral Form
13 Medicaid 5887 DSS-3973 Notice of Decision on your Medicare Assist Application
13 Medicaid 5473 DSS-41 Medicaid Presumptive Eligibility for Pregnant Women
13 Medicaid 5664 DSS-4198 Third Party Data Sheet
13 Medicaid 8475 DSS-4362 PPRI for Care At Home Waiver Program
13 Medicaid 6483 DSS-4449-B Identifying Data Form from ALPS Provider
13 Medicaid 6487 DSS-4449-C1 Medical Evaluation
13 Medicaid 6453 DSS-4449-D1 Assisted Living Program Nurs/Functional/Social Assessment
13 Medicaid 8799 DSS-445S ALP MA Recipient Absence Roster
13 Medicaid 5712 DSS-4592 Medicare Premium Payment Program Application
13 Medicaid 6406 DSS-466T Cardiovascular Medical Report
13 Medicaid 5533 DSS-4834 Third Party Health Insur Data Medicare Coverage Update
13 Medicaid 5480 DSS-486 Medical Report for Determination of Disability
13 Medicaid 5481 DSS-486T Medical Report for Determination of Disability
13 Medicaid 5672 DSS-515 Application for Medical Assistance and Addendum
13 Medicaid 5854 DSS-5472 Complaint of Non-Compliance
13 Medicaid 5446 DSS-639 Disability Review Team Certificate
13 Medicaid 5729 DSS-746 Route Slip
13 Medicaid 5668 DSS-901 Hospital Response to MAP 403A Request for Additional Info
13 Medicaid 5805 Duplication of Data Verification in Determining MA Eligibility
13 Medicaid 8816 EDITS Deferral Message
13 Medicaid 8691 EIS Request Pocket
13 Medicaid 5823 Eligibility Detail Inquiry
13 Medicaid 6401 Eligibility for Medical Assistance City of NY
13 Medicaid 5921 Eligibility Information
13 Medicaid 8566 Endocrinology Lab
13 Medicaid 8498 Executed Supplement Needs Trust
13 Medicaid 5861 Explanation of the Effect of Transfers of Resources on Medical Eligib
13 Medicaid 6475 Fair Hearing Compliance
13 Medicaid 8778 Fair Hearing Division Evidence Packet Request
13 Medicaid 8415 FHP Dis-enrollment form
13 Medicaid 9093 FHU/NHED Conference Request
13 Medicaid 6477 Fiscal Assessment
13 Medicaid 6478 Fiscal Assessment Control Form
13 Medicaid 8418 G-639, Freedom of Information/Privacy Act Request
13 Medicaid 8568 Gastroenterology Lab
13 Medicaid 8576 General Surgery Lab
13 Medicaid 8783 Good Cause Provider Transfer
13 Medicaid 8510 Guardianship paper
13 Medicaid 7903 HA 1151 Medical Statement To Do Work-Related Activities Physical
13 Medicaid 7904 HA 1152 Medical Statement To Do Work-Related Activities Mental
13 Medicaid 8205 HC - Service Section Packet
13 Medicaid 7975 HC-Care at Home Back-File Packet
13 Medicaid 7985 HC-Casa II Back-File Packet
13 Medicaid 7986 HC-Casa III Back-File Packet
13 Medicaid 7987 HC-Casa IV Back-File Packet
13 Medicaid 7976 HC-Casa O Back-File Packet
13 Medicaid 7988 HC-Casa V Back-File Packet
13 Medicaid 7989 HC-Casa VI Back-File Packet
13 Medicaid 7990 HC-Casa VII Back-File Packet
13 Medicaid 7991 HC-Casa VIII Back-File Packet
13 Medicaid 7992 HC-Casa X Back-File Packet
13 Medicaid 7970 HCA-06 Request for Verification of Birth
13 Medicaid 8346 HCBS Waiver Authorization
13 Medicaid 8347 HCBS Waiver Termination
13 Medicaid 7167 HCFA-485 Home Health Certification Plan of Care Dept HHS-HCFA
13 Medicaid 7282 HCFA-566 - Medicare Managed Care Disenrollment Dept HSS-HCFA
13 Medicaid 7214 HCFA-R-296 Home Health Advance Beneficiary Notice HHABN
13 Medicaid 6476 HCSP 3000E Fair Hearing Compliance Notice
13 Medicaid 6484 HCSP-3000 Notice of Initial Authorization of Home Care Cases
13 Medicaid 6329 HCSP-3000A Home Care Services Program
13 Medicaid 6462 HCSP-3000B Notice of Decision Not to Change Home Care Services
13 Medicaid 6330 HCSP-3000C Notice of Denial of Home Care Services
13 Medicaid 7113 HCSP-3000G Notice of Intent to Discontinue Home Care Services
13 Medicaid 8037 HCSP-3000H Notice of Decision for Personal Emergency Response Services
13 Medicaid 8035 HCSP-3000J Notice of Decision to Change Home Care Services Change
13 Medicaid 8036 HCSP-3000L Notice of Decision to Change Home Care Services Technical
13 Medicaid 8038 HCSP-3000M Notice of Decision to Change Home Care Services Other-Med
13 Medicaid 6467 HCSP-3000T Notice of Decision to Change Home Care Services
13 Medicaid 8126 HCSP-3000Y History Sheet
13 Medicaid 7161 HCSP-3005A Decisn Notice Re Auth or Increase Task Based Service Plan
13 Medicaid 8796 HCSP-3021 Case Submission Transmittal Enrollments
13 Medicaid 8837 HCSP-3022 MLTC Medicaid Cover Sheet
13 Medicaid 8781 HCSP-3026 ALP Medicaid Cover sheet
13 Medicaid 8782 HCSP-3027 Notice of Determination for Acceptance to ALP
13 Medicaid 8866 HCSP-3032 Home Care Quality Control Signature Form
13 Medicaid 8906 HCSP-3033 Spousal Refusal Referral
13 Medicaid 8907 HCSP-3034 HCSP Case Record Audit Form
13 Medicaid 8925 HCSP-3035 MLTC Housekeeping Conversion
13 Medicaid 9102 HCSP-3047b MLTC/NHED Cover Sheet
13 Medicaid 5803 HCSP-709 Confirmation of Home Visit Request
13 Medicaid 7114 HCSP-709A Request for Telephone Call
13 Medicaid 7115 HCSP-L642 Long Term Home Care Prog Provider or CASA Transmittal
13 Medicaid 5775 Health and Hospitals Corporation - Hospital Eligibility Division Pre-S
13 Medicaid 8569 Hematology/Oncology Lab
13 Medicaid 6583 HHC 045F1 HHC - Report
13 Medicaid 5544 HHC-CD590 Hospital State of Patient Inability to Sign Citizenship
13 Medicaid 5545 HHC-ES-590 Hospital Patient Inability to Sign Citizen Alien Declar
13 Medicaid 8652 HIPAA Authorizations
13 Medicaid 8653 HIPAA Request Packet
13 Medicaid 8587 Home Care Medicaid Packets
13 Medicaid 5616 Hospital Bill For Excess Income and/or Resource Case
13 Medicaid 6213 Hospital Computer printout of patient information
13 Medicaid 5768 Hospital Eligibility Tracking System Referral Form
13 Medicaid 5797 Hospital Request for Sex or Date of Birth Error Correction
13 Medicaid 7164 HR-11 Notice Admit to Congregate Care Rebudget SNA Grant Transfer
13 Medicaid 6214 HRA Info line NPA Medicaid Tracer
13 Medicaid 7947 HRA W-333C Activities of Daily Living
13 Medicaid 7948 HRA W-333D Physician Assessment Form
13 Medicaid 7949 HRA W-333E Travel Capacity Assessment - Reviewer Outcome Form
13 Medicaid 7950 HRA W-333F Medical Release of Information
13 Medicaid 7370 HRA/DIV of Accts Receivable, Receipt for Payments (MAP Pay-in Prog.)
13 Medicaid 7414 Hurricane Katrina Evacuee -DASC Universal Intake Form MISCA
13 Medicaid 8780 I-220A DOHS Immigration and Customs Enforcement
13 Medicaid 5868 Important Notice of Decision on your MA Application Community Covera
13 Medicaid 5637 Important Notice to Parents of Children with Income MAP-2087E
13 Medicaid 5787 Information about special medical exam needed for continuation of Me
13 Medicaid 5746 Information Concerning Medical Assistance for SSI Beneficiaries
13 Medicaid 5702 Inpatient New York City Health and Hospital Corp CRT Clearance Form
13 Medicaid 5774 Institutional Care or Nursing Homes Request for Information
13 Medicaid 8942 IREA’s Liens and Recovery Correspondence
13 Medicaid 7515 Katrina-02 E-S Notice: Discontinuance Of Disaster Relief MA Cover
13 Medicaid 7516 Katrina-03 E-S Notice Of Renewal Of Medical Assistance Coverage
13 Medicaid 7946 LDSS-1151 Disability Interview
13 Medicaid 5857 LDSS-2642P Documentation Checklist for Pregnant Teens/Young Children
13 Medicaid 8681 LDSS-2831A Temporary Medicaid Authorization
13 Medicaid 9044 LDSS-3139 Home Assessment Abstract
13 Medicaid 9090 LDSS-3559 Residential Health Care Facility Report
13 Medicaid 8832 LDSS-4146 Notice of Your Decision on MA Application
13 Medicaid 9045 LDSS-4362 NYSDOH Pediatric Patient Review
13 Medicaid 8797 LDSS-4623A Adoption Subsidy/Non-Recurring Adoption Expenses Agreement
13 Medicaid 8835 LDSS-4687 Managed Care Action Taken
13 Medicaid 7945 LDSS-486T Medical Report for Determination of Disability
13 Medicaid 8817 LDSS-4882 Application/Referral for Child Support Services
13 Medicaid 8872 LDSS-639 HCSP Centralized Medicaid Eligibility Unit
13 Medicaid 8987 LDSS/HRA Marketplace Application Documentation
13 Medicaid 5762 Letter to Past or Present Employer
13 Medicaid 5546 LO-406S Benefits Paid-Copy of Check-Statement of
13 Medicaid 6486 Local Medical Director Review Form
13 Medicaid 5804 Long Term Care Division Clearance Form
13 Medicaid 6219 Longterm Care Facility Rpt MA Recipient Adms/Readmi or Disch DSS
13 Medicaid 8776 LTHHC Respiratory Therapy Evaluation
13 Medicaid 8328 LTHHCP4323 Intent to Discontinue Your Participation
13 Medicaid 8329 LTHHCP4325 Authorize/Reauthorize or Deny Your participation
13 Medicaid 8330 LTHHCP4327 Reduce Your SNF Level Budget to HRF Level Budget
13 Medicaid 8331 LTHHCP4339 Notice of Intent to Reduce/Discontinue Services
13 Medicaid 8332 LTHHCP4341 Notice of Intent to Deny Services
13 Medicaid 6494 M-11a or M-11V OHCS/MAP Transmittal with to Computer Operations
13 Medicaid 6333 M-11c Home Care Field Questionnaire
13 Medicaid 6334 M-11d Home Care Reauthorization Assessment
13 Medicaid 5492 M-11G Reauth-Recert Statement for Home Care Clients
13 Medicaid 6485 M-11q Letter mailed to Client with
13 Medicaid 6335 M-11s Home Care Social Assessment
13 Medicaid 5864 M-11v Home Care Services Program Stop Service Auth or Adjust Billin
13 Medicaid 6456 M-13d CDPAP Application
13 Medicaid 6491 M-13v Notice of Decision on CDPAP Application
13 Medicaid 6501 M-14p Special HA or HHA Request & Authorization
13 Medicaid 6493 M-27r Addendum Nursing Assessment Follow-up
13 Medicaid 6339 M-27R Nurse's Assessment Visit Report
13 Medicaid 7023 M-27t Nurse's Supervisory Visit Report
13 Medicaid 5694 M-28A Home Care Reviewers Decision
13 Medicaid 6496 M-28q Personal Emergency Response Services Evaluation Form
13 Medicaid 7162 M-28x Pending Team Telephone Assessment Document HCSP-4 pages
13 Medicaid 5883 M-322R Newborn Child Accepted for Medicaid Coverage
13 Medicaid 5717 M-3T Notice of Ineligibility of Application for Medical Assistance
13 Medicaid 6943 M-42q Certification For Retroactive Medicaid Coverage
13 Medicaid 6867 M-42v Medicaid Choice or Managed Care Referral
13 Medicaid 6473 M-485 Doctor's Order or Plan of Care
13 Medicaid 1716 M-76j Consent for Disclosure of MAP Records of ASA Treatment
13 Medicaid 8114 M-858G Notice of Refund of Home Energy Allowance Deduction
13 Medicaid 8088 M11Q-Medical Request for Home Care Services
13 Medicaid 8798 MA Model Waivers CAH I & II Program
13 Medicaid 8287 MA Only Package HASA
13 Medicaid 8955 MAGI Group Screening Tool for Applications
13 Medicaid 5923 Mail In Recertification Statement
13 Medicaid 5779 Mail Recertification Program Referral Letter
13 Medicaid 7797 Manual Notice of Transition of MA-FHP County A
13 Medicaid 5689 MAP /E C257 Eligibility/Recertification for Medicaid, Notice of
13 Medicaid 6421 MAP /E C795 Recertification Statement
13 Medicaid 6356 MAP /E E11 Transmittal to Statistical Section of Educational AID Cases
13 Medicaid 6311 MAP /E H403A Request for Additional Information
13 Medicaid 6246 MAP 1016C Request for Public Transportation Reimbursement
13 Medicaid 5843 MAP 2004W Batch Transmittal
13 Medicaid 6342 MAP 2008 Third Party Health Insurance TPHI Report for PWA Application
13 Medicaid 5661 MAP 2016 Prescreening Referral
13 Medicaid 5487 MAP 2025W Over the Counter Case Documentation Checklist
13 Medicaid 6826 MAP 2033K Fair Hearing Notice Acceptance FHP Application
13 Medicaid 5489 MAP 2033M Pre Fair Hearing Summary
13 Medicaid 5691 MAP 2033N Fair Hearing Decision Notice
13 Medicaid 5635 MAP 2050E Medical Assistance Program Benefits Checklist
13 Medicaid 6412 MAP 2052M Request for Approval of Taxi or Car Service Fare
13 Medicaid 5514 MAP 2069A Structured Surplus Income Program History Sheet
13 Medicaid 5644 MAP 2070W Institutionalized Budget Assessment Worksheet
13 Medicaid 5720 MAP 2083A Out of Pocket Reimbursement List
13 Medicaid 6499 MAP 2091N Return Form CASA Medical Review Team, Sent to Service Team
13 Medicaid 5911 MAP 2092B Temporary Absence Unit Case Control
13 Medicaid 5727 MAP 2094A Recertification Statement for Home Care Clients
13 Medicaid 5690 MAP 2100D MAP 201 Employment History of
13 Medicaid 6407 MAP 2116M Request for Simplified Asset Review for Medicaid Eligibility
13 Medicaid 5904 MAP 2124A Selective Supervisory Review Completed Case Log
13 Medicaid 6306 MAP 2162T Which Application Form Do I Need Reverse in Spanish
13 Medicaid 5699 MAP 2172D Important Notice About Medicaid Reimbursement
13 Medicaid 6309 MAP 861 State Quality Control Case Requiring Corrective Action
13 Medicaid 5660 MAP 931 Explanation of the Excess Income Program
13 Medicaid 5462 MAP Certification Guide for Medical Assistance Community Care Cases
13 Medicaid 5836 MAP Dear Medicaid Recipient in order to complete recertification
13 Medicaid 5687 MAP Discharge to Foster Care Placement Special Services for Children
13 Medicaid 5924 MAP Division of Hospital Eligibility or Notice of Medicaid Acceptance
13 Medicaid 5465 MAP E201 Letter to Past Present Employer
13 Medicaid 6930 MAP Facilitated Enroller Client Information (any kind)
13 Medicaid 5464 MAP Letter to Past or Present Emp Requesting Health Insurance Benefits
13 Medicaid 5926 MAP Medicaid Transportation Prior Approval of Non emergency Ambulance
13 Medicaid 8702 MAP MLTC Medicaid Application Checklist
13 Medicaid 5675 MAP QPA-0488 Application/Reconsideration Transmittal and Receipt
13 Medicaid 5505 MAP Request for Documentation Info for Recert Community Elig Division
13 Medicaid 5648 MAP- 2087 DIS Discontinue Medical Assistance-Notice of Intent to
13 Medicaid 7059 MAP-0911D Notice of update on your Disaster Relief Medicaid
13 Medicaid 6836 MAP-0911N Notice of Denial of Medicaid (FHP/DR)
13 Medicaid 7056 MAP-0911T Failure to Appear at Face to Face Interview (DRM)
13 Medicaid 7050 MAP-101 MBI-WPD Prescreening Document (Buy-In Program)
13 Medicaid 7058 MAP-1016F Change of Address form
13 Medicaid 6197 MAP-1016H0 Complaint Resolution Form
13 Medicaid 8399 MAP-101F Photograph Referral-CBIC Card
13 Medicaid 6674 MAP-1049f Child Health Plus A or B Separate Determination Referral
13 Medicaid 7335 MAP-1058B(E-S) Notice of Intent to Discontinue your MA Restriction
13 Medicaid 5547 MAP-1094B Child Health Plus Information
13 Medicaid 6843 MAP-1094F Child Hlth. Plus A/B Separate Determination Referral
13 Medicaid 7839 MAP-1096 Child/Teen Health Plan Fact Sheet
13 Medicaid 6805 MAP-1096K 06/07/02 Child/Teen Health Program Client Affirmation
13 Medicaid 7336 MAP-1096M (E-S) C/THP Reply Form
13 Medicaid 5447 MAP-1122 Discharge Alert
13 Medicaid 5771 MAP-1123 Change or Cancellation in Discharge Plan MAP-259E replaces
13 Medicaid 5488 MAP-1124 Planned Discharge Notice MAP-259F replaces
13 Medicaid 5641 MAP-1389 Fair Hearing Compliance Follow-up Notice
13 Medicaid 8868 MAP-173a Request for Current Status of MSP Application
13 Medicaid 6409 MAP-1755 Medicare Online System-Benefits Status
13 Medicaid 7062 MAP-2001C Notice of Continuation of MA Elig. after Recertification
13 Medicaid 5863 MAP-2002 Formerly MAP/E 1127-Discharge Unit Planning Log
13 Medicaid 5515 MAP-2003B Supplemental PICKLE Amendment Questions
13 Medicaid 5520 MAP-2003H Veterans Benefits Questionnaire
13 Medicaid 5501 MAP-2007 Referral to Disability Review Division
13 Medicaid 5549 MAP-2008H Veterans Benefits Questionnaire
13 Medicaid 8905 MAP-2009f Notice to Insurance Carrier to Recognize/Pay Provider
13 Medicaid 5931 MAP-2010D Notice of Denial of Your nursing Home Application
13 Medicaid 5550 MAP-2016A Application Control Card-Copy 3
13 Medicaid 6844 MAP-2016H Notice of Deferral - Access NY Health Care
13 Medicaid 5506 MAP-2016H Request for Documentation Information
13 Medicaid 5632 MAP-2016M Prescreening Interview Checklist
13 Medicaid 5461 MAP-2016P Interview Guide History Sheet
13 Medicaid 5420 MAP-2016R Application Control Card
13 Medicaid 7337 MAP-202 (E-S) Homebound Food Stamp Application Cover Letter
13 Medicaid 8255 MAP-2020X FHP-Premium Assistance Program Outreach Notice - Acceptance
13 Medicaid 8524 MAP-2020Y Family Health Plus-Premium Assistance Program
13 Medicaid 6410 MAP-2025C CED Manual Recertification Log
13 Medicaid 8704 MAP-2025D Request For Documentation/Information For Recertification
13 Medicaid 7116 MAP-2025G Recertification Request for Resource & Income Verification
13 Medicaid 5878 MAP-2025H Notice of Assistance From Facilitated Enrollers
13 Medicaid 6886 MAP-2025J Pre-Screening Doc. Checklist and Reg. Case Type(s) Assign.
13 Medicaid 5450 MAP-2025S Earned Income and Health Insurance Questionnaire
13 Medicaid 5494 MAP-2025Z Recert Request for Resources and Income Information
13 Medicaid 5932 MAP-2026 Form SS-5 Transmittal Letter
13 Medicaid 5551 MAP-2026A Confirmation of Identity-Request for
13 Medicaid 8912 MAP-2026a Social Security Number Verification
13 Medicaid 5552 MAP-2026C Bank Account Information-Request for
13 Medicaid 5553 MAP-2026H Confirmation of Identity-Request for
13 Medicaid 7229 MAP-2026J Attestation of Effort To Apply For SS Number (For Medical Assistance)
13 Medicaid 7824 MAP-2026K Request For Certification of Birth NYC
13 Medicaid 7825 MAP-2026M Request For Certification of Birth
13 Medicaid 8892 MAP-2026Q Request for Health Insurance Information from Employer
13 Medicaid 8028 MAP-2026U Request for Social Security Number State Benefits
13 Medicaid 6837 MAP-2028J Instruction for Mailing Health Ins. Premium
13 Medicaid 7338 MAP-202A (E-S) Homebound Food Stamp Application Questionnaire
13 Medicaid 7052 MAP-2030 Notice Regarding Residency
13 Medicaid 7053 MAP-2030A County Commissioner Letter
13 Medicaid 7209 MAP-2030C Notice Regarding Residency
13 Medicaid 7320 MAP-2030D Residence/Mailing Address Inquiry
13 Medicaid 6892 MAP-2031B Consent to Release Information
13 Medicaid 6838 MAP-2033B Fair Hearing Notice of Denial of MA/FHP
13 Medicaid 6839 MAP-2033C Fair Hearing Plan Selection Notice
13 Medicaid 5692 MAP-2033H Fair Hearing History Sheet
13 Medicaid 6628 MAP-2033P Fair Hearing Summary
13 Medicaid 6825 MAP-2033R-Fair Hearing Compliance Follow-up Notice
13 Medicaid 5782 MAP-2043F Request For Resource Information Lawsuit Settlement
13 Medicaid 7118 MAP-2043K Referral to Office of Revenue and Investigation
13 Medicaid 5900 MAP-2043Y Referral Concerning Real Property of Institutional Individ
13 Medicaid 7900 MAP-2050 Client Statement of Monthly Expenses
13 Medicaid 5431 MAP-2050 Client Statement of Monthly Expenses
13 Medicaid 5700 MAP-2050 Important Notice for Medicaid Recipients/Medical Assistance
13 Medicaid 5440 MAP-2050A Declaration of Income or Support For Medical Assistance
13 Medicaid 7896 MAP-2050A Declaration of Income Support
13 Medicaid 5439 MAP-2050B Declaration of Support Mail Recertification
13 Medicaid 7339 MAP-2050G Resource Verification/Attestation (For Medical Assistance)
13 Medicaid 7394 MAP-2050H Processing FHP Cases With Resources Over Resource Limit
13 Medicaid 8129 MAP-2050J Equity Statement House or Condominium or Co-Op Apartment
13 Medicaid 5443 MAP-2052A Disability Determination Worksheet
13 Medicaid 5696 MAP-2052B How to Obtain Medicaid in the Aid to the Disabled Category
13 Medicaid 5504 MAP-2052C Request for Additional Medical Information
13 Medicaid 7793 MAP-2052G Information About Special Medical Exam
13 Medicaid 7754 MAP-2052H Notice of Equipment for CE
13 Medicaid 6413 MAP-2052N Authoriz for Taxi Car Service for Consultive Examination
13 Medicaid 5688 MAP-2052R DRS Consultive Examination or test order form
13 Medicaid 8663 MAP-2055n Medicaid FHPlus and Kids Insurance
13 Medicaid 5426 MAP-2060 Budget Explanation
13 Medicaid 5844 MAP-2060A Catastrophic Budget Explanation
13 Medicaid 5454 MAP-2060B Expensive Hospital Care Budget Explanation
13 Medicaid 5425 MAP-2060C Budget Explanation-Institutional Services
13 Medicaid 7340 MAP-2060D Budget Explan. Institut. Serv. Adj NAMI Based On Med Bills
13 Medicaid 6923 MAP-2060E Zero NAMI Request - Viable Bills worksheet
13 Medicaid 6878 MAP-2060G Request Payment for NH Services Retroactive Two Yrs or More
13 Medicaid 6872 MAP-2060J Budget Explanation - Nursing Home Eligibility Division
13 Medicaid 6879 MAP-2061B Consent to Release Information
13 Medicaid 5516 MAP-2069B Surplus Income Ledger Replaced by MAP-802V
13 Medicaid 6835 MAP-2069F Denial of your Disaster Relief Medicaid/FH Plus, Notice of
13 Medicaid 5667 MAP-2069K Surplus Income-Notice of
13 Medicaid 6536 MAP-2069N Medical Expenses Paid or Incurred By a Public Program
13 Medicaid 5650 MAP-2070A Spouse-Notice to-New Case
13 Medicaid 7341 MAP-2070B Notice To Spouse (Undercare)
13 Medicaid 5642 MAP-2070G Notification of Permanent Absence Status or Status Change
13 Medicaid 5649 MAP-2070N Estab a Liability toward Chronic Care-Notice of Intent to
13 Medicaid 7342 MAP-2070P Notice Of Assessment
13 Medicaid 8130 MAP-2070W Institutionalized Spouse Budget Worksheet
13 Medicaid 7343 MAP-2070X Community Spouse Monthly Income Allowance Refusal Statemnt
13 Medicaid 5653 MAP-2074 Medicaid Authorization-Statement of
13 Medicaid 6927 MAP-2075F Substance Abuse Case Control Referral
13 Medicaid 5723 MAP-2078A Payment Request Form
13 Medicaid 5840 MAP-2079A Approval Form for Temporary Medicaid Authorization
13 Medicaid 6877 MAP-2080J Budget Explanation - NHED non spousal cases
13 Medicaid 5554 MAP-2081 Documentation Information Tape-Request for
13 Medicaid 5424 MAP-2081A Authorization to Release Information
13 Medicaid 5721 MAP-2083E Paid Medical Bills Reimbursement Notice
13 Medicaid 6785 MAP-2083H Medical Assistance/Home Care Reimbursement Detail Form
13 Medicaid 8869 MAP-2083j Out-Of-State Billing
13 Medicaid 7082 MAP-2083P Provider Enrollment Letter
13 Medicaid 5734 MAP-2086 Conference and Fair Hearing Information
13 Medicaid 7344 MAP-2086A (E-S) Right To A Conference
13 Medicaid 7218 MAP-2086B Conference And Fair Hearing Information
13 Medicaid 8397 MAP-2087a Denial of Your Application for Public Health Insurance
13 Medicaid 8920 MAP-2087ah Denial of Your Appl for Public Health Insurance (H25/H26)
13 Medicaid 5555 MAP-2087B Change Medical Assistance-Notice of Intent to
13 Medicaid 5556 MAP-2087c Notice of Intent to Discontinue Medical Assistance- (All)
13 Medicaid 7119 MAP-2087V Decision Notice: on Elig. for MA Buy-In(AC MA-Only Recip.)
13 Medicaid 7345 MAP-2088 Decision Notice On Your MA Application (Transfer of Assets)
13 Medicaid 7157 MAP-2088B Decision Notice: MA Appl. Nursing Home Serv. was MEP-2088B
13 Medicaid 7346 MAP-2088C Notice Of Intent To Change Medicaid Coverage
13 Medicaid 7158 MAP-2088E Acceptance Notice, Limited Coverage MA Appl (Surplus Inc.)
13 Medicaid 5663 MAP-2088H Notice of Acceptance of Your MA Application Pregnancy
13 Medicaid 5557 MAP-2088I Acceptance of your Medicaid Application Notice of
13 Medicaid 7892 MAP-2088N Notice of Action for Payment of Cobra Coverage
13 Medicaid 7396 MAP-2088v Notice of Renewal of Your Public Health
13 Medicaid 7347 MAP-2089A Notice of Change in Your Net Available Monthly Income (NAMI)
13 Medicaid 8494 MAP-2089c Continuing Medicaid Coverage Children Under 19 Years of Age
13 Medicaid 7348 MAP-2089Q Notice To Discontinue Your Full MA Coverage (Code 07)
13 Medicaid 6103 MAP-2090A Notification of Quality Control Finding
13 Medicaid 5839 MAP-2091P Acknowledgement Letter
13 Medicaid 7160 MAP-2091Q MES/Service Team Medicaid Applicant Info. Exchange (CASA)
13 Medicaid 5683 MAP-2091W Community Alternative Systems Agency
13 Medicaid 5559 MAP-2094L Recertification Statement MRP
13 Medicaid 5500 MAP-2094L Recertification Statement MRP Formerly MEP-2094L
13 Medicaid 6842 MAP-2094P Stenson History Sheet
13 Medicaid 6043 MAP-2094Z Important Information about Medicaid Cards
13 Medicaid 6414 MAP-2096 Instruct for Preg Teenagers and First-Time Mothers Accepted
13 Medicaid 7057 MAP-2096B Growing up Healthy Recert Persons Under age 19
13 Medicaid 7599 MAP-2096F/2096G Renewal Original/Reminder Form
13 Medicaid 6821 MAP-2096J - Terms Rights And Responsibilities
13 Medicaid 6834 MAP-2096M Medicaid/Family health Plus - Recert Reminder Notice
13 Medicaid 6810 MAP-2096N Notice Regarding Your Medical Assistance-Mail Renewal E-S
13 Medicaid 8795 MAP-2096q Renewal Instructions
13 Medicaid 8128 MAP-2096V No Longer Eligible for Medicaid on Parents Case
13 Medicaid 6763 MAP-2097 Client Affirmation Application Checklist
13 Medicaid 6764 MAP-2097A Program Selection or Pregnancy
13 Medicaid 8365 MAP-2097c Notice of Change from Full MA to Family Health Plus
13 Medicaid 6822 MAP-2097J-Notice of FHP Acceptance of Your Health Insurance Appl
13 Medicaid 6773 MAP-2097K Health Insurance Eligibility Screening Worksheet
13 Medicaid 8586 MAP-2097L Change Medicaid Coverage to Family Health Plus
13 Medicaid 6887 MAP-2097TNotice of Change From MA to FHP (Mail Renewal)
13 Medicaid 6779 MAP-2097V Information About Parents/Spouses Not Living in Household
13 Medicaid 6840 MAP-2097W Notice of Denial of Hlth Ins Appl F.E./Excess Inc/Resources
13 Medicaid 8417 MAP-2097Y Important Notice of Change from FHP to MA
13 Medicaid 5519 MAP-20Transmittal for PSA for Adults Medicaid Eligibility
13 Medicaid 5684 MAP-2100A Conference Unit Resolution Control
13 Medicaid 5676 MAP-2100B Appointment for Conference
13 Medicaid 6353 MAP-2105 Request for Amend to a Petition to Appoint a Conserv Commit
13 Medicaid 5561 MAP-2105H Request for Bank Account Information
13 Medicaid 5562 MAP-2105N Request for Account Information
13 Medicaid 8127 MAP-2105Y Request to Amend a Petition to Appoint a Guardian
13 Medicaid 5476 MAP-2109A Medicaid Resource History
13 Medicaid 7051 MAP-2116K Hospital Request for MA Coverage for ALOC Days
13 Medicaid 5509 MAP-2116M Request for Simplified Asset Review for Medicaid Eligibility
13 Medicaid 6416 MAP-2120G Medicaid Recertification Documentation for Home Care Cases
13 Medicaid 5565 MAP-2121H Home Visit Request
13 Medicaid 5512 MAP-2123 Statement in Support of Claim Veterans Administration 21-4138
13 Medicaid 6504 MAP-2131 Agreement Relative Friend Participate in Home Care Services
13 Medicaid 5853 MAP-2134A Community Senior Service Network Project Transmittal Form
13 Medicaid 5566 MAP-2135 Burial Fund Acknowledgement
13 Medicaid 6216 MAP-2136 Institutional Services Certification Guide
13 Medicaid 5463 MAP-2136A Interview Certif Guide for MA Hospital In-Patient Cases
13 Medicaid 5453 MAP-2137 Expedited Application Tracking Form Central HED
13 Medicaid 5513 MAP-2150 Statement of Medical Condition
13 Medicaid 5471 MAP-2150A MCU Physician Review Form
13 Medicaid 5429 MAP-2151 Certification of Treatment of Emergency Medical Condition
13 Medicaid 6417 MAP-2151A Letter to Attending Physician
13 Medicaid 5568 MAP-2151C Alien Desk Aid
13 Medicaid 5569 MAP-2151D Notice of Resettlement Agency
13 Medicaid 7350 MAP-2151K Decision Notice To Close Your Emergency MA Coverage Case
13 Medicaid 7055 MAP-2153A Hospital Request for Medicaid Claim Number
13 Medicaid 5570 MAP-2158 Medicare Buy- In Program Eligibility Review
13 Medicaid 5596 MAP-2158B Medicare Buy-In Program Eligibility Review
13 Medicaid 5572 MAP-2158C Buy Medicare Buy-In Addition Transmittal
13 Medicaid 7159 MAP-2158E Client Request to be Removed From The Medicare Buy-In
13 Medicaid 6944 MAP-2158F Medicare Buy-In Deletion Transmittal
13 Medicaid 5573 MAP-2158H Health Insurance Transmittal
13 Medicaid 5784 MAP-2158P Request For Part A - Medicare Savings Program
13 Medicaid 5719 MAP-2159 Notification of Change or Correction to file from nursing
13 Medicaid 5597 MAP-2159A Medicaid Questionnaire for RHCF Residents
13 Medicaid 5934 MAP-2159B Nursing Home Eligibility Division ORI Tracking Report
13 Medicaid 5933 MAP-2159C Transmittal for Nursing Facility Medicaid Applications
13 Medicaid 8627 MAP-2159G Notice of Denial for Managed Care Disenrollment
13 Medicaid 7293 MAP-2159K MA Nursing Home Excess Remittance Report ONE client only
13 Medicaid 5846 MAP-2159Q Certification of Receipt of German Reparation
13 Medicaid 6876 MAP-2159W RHCF - Disenrollment Request
13 Medicaid 8867 MAP-215b Medicaid Coverage for an Emergency Medical Condition
13 Medicaid 7397 MAP-216 Request for Documentation (Mail Renewal)
13 Medicaid 5576 MAP-2160 Transfer of Assets Worksheet
13 Medicaid 5437 MAP-2161 Applicant Recipient Declaration Concerning Relative’s Income
13 Medicaid 5441 MAP-2161A Declaration of the Legally Responsible Relative
13 Medicaid 5448 MAP-2162E Documentation Certification Checklist
13 Medicaid 5475 MAP-2162H Continued Medicaid Coverage for Newborn Babies
13 Medicaid 5633 MAP-2162H Continued Medicaid for Newborn Babies
13 Medicaid 5662 MAP-2162N Certification Program Prenatal Care Assistance Program
13 Medicaid 5577 MAP-2162Q Request for Documentation Medicaid WIC
13 Medicaid 6354 MAP-2163 NY NY Connect Progr Enroll Request MAP Clearance and Decision
13 Medicaid 9111 MAP-2166 Comprehensive Medicaid Case Management Enrollment Request
13 Medicaid 9112 MAP-2166a Comprehensive Medicaid Case Management Disenrollment Request
13 Medicaid 7322 MAP-2166B Comprehensive Medicaid Case Management Transfer Request
13 Medicaid 8394 MAP-216D Request for Documentation-Quality Control Unit
13 Medicaid 5634 MAP-217 BEV Appointment Letter
13 Medicaid 5578 MAP-2174C BEV Appointment Notice
13 Medicaid 5469 MAP-2174D MAP Referral to BEV
13 Medicaid 5579 MAP-2175 Notification to Clients about Alcoholism & SA Req. for MA
13 Medicaid 5631 MAP-2175A Medical Assistance Program Referral to SACC
13 Medicaid 5800 MAP-2175B Disclosure Consent Alcohol or Drug Abuse Treat Prgrms Rcrds
13 Medicaid 6880 MAP-2175D Dept Health & Mental Hygiene(DMH) Prescreening(BRADH unit)
13 Medicaid 5507 MAP-221 Request for Information on Income Producing Property
13 Medicaid 8665 MAP-228D Facilitated Enroller Selection Letter
13 Medicaid 6743 MAP-25 MAP-2014 Medicaid Separate Determination History Sheet
13 Medicaid 8409 MAP-252A Request to Complete Form DSS-486T
13 Medicaid 7398 MAP-252E Disability Review Referral (CHP A)
13 Medicaid 6866 MAP-252F AIDS or AIDS Related Complex Medical Report
13 Medicaid 7951 MAP-252F Aids or Aids Related Complex Medical Report
13 Medicaid 7487 MAP-252G Notice Of Disability Determination (CHP A Eligibility)
13 Medicaid 6897 MAP-255 Language Questionnaire
13 Medicaid 6418 MAP-2559 Health Insurance Questionnaire
13 Medicaid 7972 MAP-258A Notice of Change to Your Medicare Savings Program Coverage
13 Medicaid 7381 MAP-258D Notice Concerning Eligibility for the Medicare Savings Program
13 Medicaid 7526 MAP-258E Client Request: Remove from MA Svngs Prgrm (rplc MAP-2158E)
13 Medicaid 7488 MAP-258F Notice To Medicare BuyIn Applicant With Excess Income (OED)
13 Medicaid 8401 MAP-258g Notice to Consumer Regarding Medicare Savings-Post Budget-OED
13 Medicaid 7353 MAP-258K Decision Notice: Application/ReEnrollment to MA Savings Pgm
13 Medicaid 5711 MAP-258M Medicare Buy-In Program Eligibility Review
13 Medicaid 8605 MAP-258n Notice of Change to Your Medicare Savings Program (MSP)
13 Medicaid 8603 MAP-258t Medicare Savings Program Outreach Notice
13 Medicaid 7899 MAP-258V Medicare Savings Program Deferral Notice (OED)
13 Medicaid 7898 MAP-258X Medicare Savings Program Deferral Notice (C-REP)
13 Medicaid 7354 MAP-259 Auth. For Short-Term Rehabilitative Nursing Home Care (RVI)
13 Medicaid 7355 MAP-259A Notice MA Recert. Elig. Decision (Institut. /Nursing Homes)
13 Medicaid 7207 MAP-259B Notice Of Denial Of Your Nursing Home Application
13 Medicaid 8521 MAP-259c Medicaid Coverage Start Date
13 Medicaid 7493 MAP-259C Revision of "Pick Up" Date (Nursing Homes)
13 Medicaid 8145 MAP-259D Discharge Alert
13 Medicaid 7382 MAP-259E Change / Cancellation in Discharge Plan (Replaces MAP-1123)
13 Medicaid 7383 MAP-259F Discharge Notice (Replaces MAP-1124)
13 Medicaid 7384 MAP-259G Respite Stay
13 Medicaid 8029 MAP-259H Consumer Intent to Return / Not to Return Home
13 Medicaid 5925 MAP-259N Conversion of Former Nursing Facility Case
13 Medicaid 7513 MAP-259P Notice of Acceptance Of Your MA Application (HCSP-MLTC)
13 Medicaid 8697 MAP-259q Notice of Spouse
13 Medicaid 5718 MAP-259r Notice to Community Spouse Concerning Income
13 Medicaid 5640 Map-259T Conversion of Active PA or SSI case to Nursing Facility Care
13 Medicaid 8523 MAP-259t Request to Convert Case
13 Medicaid 8608 MAP-259v Notice of Decision on Your Medical Assistance for LTC Service
13 Medicaid 8137 MAP-259W Contribution Toward Chronic Care Costs
13 Medicaid 7837 MAP-259Y Notice of Decision on your request for Undue Hardship
13 Medicaid 8382 MAP-259Z Claim of Undue Hardship (Substantial Home Equity)
13 Medicaid 7054 MAP-25A History Sheet (For LDSS-2921 and DOH-4220)
13 Medicaid 7083 MAP-25B History Sheet
13 Medicaid 8023 MAP-25D MSD History Sheet ll
13 Medicaid 7833 MAP-25E History Sheet - Surplus Income / Pay-In Program
13 Medicaid 8031 MAP-25G History Sheet (Nursing Home Eligibility Division
13 Medicaid 8024 MAP-25H Stenson ll History Sheet
13 Medicaid 8030 MAP-25J History Sheet (Medicaid Managed Care)
13 Medicaid 8479 MAP-25n History Sheet (Quality Control)
13 Medicaid 8380 MAP-25p Eligibility Information Services
13 Medicaid 8930 MAP-25q MSP-Project History Sheet
13 Medicaid 9038 MAP-25r Eligibility Information Services History Sheet (Pool Trust)
13 Medicaid 8902 MAP-262 NYC Nurse-Family Partnership
13 Medicaid 5599 MAP-2985 Notification to Hospital of Medicaid Decision
13 Medicaid 8370 MAP-3002 Surplus Income Program Decision Notice Coverage Authorized
13 Medicaid 8369 MAP-3002a Surplus Income Program Decision Coverage Not Authorized
13 Medicaid 8367 MAP-3002c Managed Care Guarantee Explanation and Consumer’s Selection
13 Medicaid 8395 MAP-3002e Notice of Change from Full MA to Surplus Income Program-MSP
13 Medicaid 8851 MAP-3002g Managed Care Options and Consumer’s Selection
13 Medicaid 8372 MAP-3004 Bridges to Health (B2H) Application Transmittal
13 Medicaid 8373 MAP-3004a Bridges to Health (B2H) Renewal Transmittal
13 Medicaid 8646 MAP-3005 Notice of Restricted Access to MAP Locations
13 Medicaid 8366 MAP-3006a Response to Request for Removal of Health Insurance
13 Medicaid 8384 MAP-3009 Request for Information Supplemental Needs Trusts
13 Medicaid 8416 MAP-3010 Request for Additional Information
13 Medicaid 8383 MAP-3011 Medical Assistance Program Program Referral and Tracking Form
13 Medicaid 8381 MAP-3014 Special Project Decision Notice No Response to Mailing
13 Medicaid 8371 MAP-3014a Special Project Notice of Denial
13 Medicaid 8374 MAP-3014b Special Project Acceptance Notice MA to MA or FHP to MA
13 Medicaid 8375 MAP-3014d Special Project Acceptance Notice FHP to FHP or MA to FHP
13 Medicaid 8368 MAP-3014e Special Project Acceptance Notice FHP to FHP or MA to FHP
13 Medicaid 8377 MAP-3014f Special Project Renewal Status Notice MA to MA or FHP to MA
13 Medicaid 8378 MAP-3014g Special Project Renewal Status Notice MA to MA or FHP to FHP
13 Medicaid 8376 MAP-3014h Special Project Renewal Status Notice FHP to FHPor MA to FHP
13 Medicaid 8391 MAP-3016 Request to Provide Income Information
13 Medicaid 8393 MAP-3017 Notice Regarding Your Eligibility For MSP
13 Medicaid 8495 MAP-3018 Confirmation Of Public Health Insurance
13 Medicaid 8651 MAP-3018a Confirmation of Public Health Insurance Coverage/Case Level
13 Medicaid 8480 MAP-3021 Nursing Home Renewal Cover Letter
13 Medicaid 8675 MAP-3022 Nursing Home Renewal
13 Medicaid 8484 MAP-3024 Follow-Up Request For Additional Proof/Information
13 Medicaid 8485 MAP-3024a Follow-Up Request For Additional Proof/Information
13 Medicaid 8606 MAP-3026a Retroactive Medicaid Need to Determine Financial Eligibility
13 Medicaid 8650 MAP-3026b Notice of Decision Regarding Medical Bills – MKB v Eggleston
13 Medicaid 8592 MAP-3030 Notice of Deferral (MIIP)
13 Medicaid 8593 MAP-3030a Final Notice of Deferral (MIIP)
13 Medicaid 8604 MAP-3031 Request for Payment of Overpayment (TPPU)
13 Medicaid 8607 MAP-3032 EDITS History Sheet
13 Medicaid 8610 MAP-3035 Notice of Intent to Discontinue Medicaid (Birth Verification)
13 Medicaid 8611 MAP-3035a Discontinue Medicaid/Family Health plus Coverage (OMR)
13 Medicaid 8612 MAP-3035b Notice of Intent to Discontinue Medical Assistance
13 Medicaid 8617 MAP-3036a Spousal Refusal Referral
13 Medicaid 8711 MAP-3036b Investigation, Revenue and Enforcement Administration
13 Medicaid 8613 MAP-3037 Referral to Investigation, IREA/BEV
13 Medicaid 8649 MAP-3038 Notice of Responsibility (Guardianship)
13 Medicaid 8648 MAP-3041 Denial of NAMI Adjustment Request
13 Medicaid 8838 MAP-3041a Notice of Intent to Change Your Net Available Monthly Income
13 Medicaid 8615 MAP-3043 Authorization to Apply for Medicaid on my Behalf
13 Medicaid 8616 MAP-3044 Facility Submission of Application on Behalf of Consumer
13 Medicaid 8618 MAP-3045 Ombudsman Unit Inquiry Form
13 Medicaid 8644 MAP-3046 Request From Plan to Change Provider and/or Pharmacy
13 Medicaid 8699 MAP-3046a Request to Change Provider/Pharmacy and or Dentist
13 Medicaid 8647 MAP-3047 Notice of Denial of Your Application For MSP (Part B)
13 Medicaid 8673 MAP-3047a Notice of Receipt of Medicare Savings Programs (MSP)
13 Medicaid 8698 MAP-3047b Your Application/Enrollment in the Medicare Savings Program
13 Medicaid 8839 MAP-3050 Note of Intent to Discontinue MA/FHP Coverage-Excess Resource
13 Medicaid 8708 MAP-3051 NHED Conference Disposition Summary
13 Medicaid 8709 MAP-3051a NHED Conference Request Summary
13 Medicaid 8710 MAP-3053 Under-care Transmittal To The Medical Assistance Program
13 Medicaid 8840 MAP-3053a Domestic Violence Transmittal to the MAP
13 Medicaid 8747 MAP-3055 Postponed Case Actions - Hurricane Sandy Notices
13 Medicaid 8852 MAP-3056 Response to Agency Conference Request (NHED)
13 Medicaid 8853 MAP-3056a Failed to Attend Agency Conference (NHED)
13 Medicaid 8794 MAP-3057 Special Income Standard for Housing Expenses
13 Medicaid 8806 MAP-3060 Late Mailing of Your DAB Renewal Notification
13 Medicaid 8834 MAP-3062 Acknowledgement of Your Request for a Time Extension (NHED)
13 Medicaid 8911 MAP-3063 Notice of Change from Medicaid Surplus To Family Health Plus
13 Medicaid 8818 MAP-3064 NHED REFERRAL TO IREA/OMPFAI
13 Medicaid 8904 MAP-3067 Request for PA Case or Line Closing Due to NH Placement
13 Medicaid 8917 MAP-3068 Site Report Victim of Severe Trafficking Applying For MA
13 Medicaid 8859 MAP-3069 Request for Agency Conference (EDITS)
13 Medicaid 8860 MAP-3069a Re-Application Submission (EDITS)
13 Medicaid 8926 MAP-3069b Request for Agency Conference (Non-EDITS)
13 Medicaid 8928 MAP-3069c Re-Application Submission (Non-Edits)
13 Medicaid 8927 MAP-3070 Third Party Health Insurance Outreach Notice
13 Medicaid 8916 MAP-3071 TPHI CER Exempt/Excluded From Managed Care
13 Medicaid 8915 MAP-3071a TPHI CER Client Not Exempt/Excluded From Managed Care
13 Medicaid 8914 MAP-3071b TPHI CER Medicare Client with Comprehensive Policy
13 Medicaid 8913 MAP-3071c TPHI CER Medicare Client with Supplemental Policy
13 Medicaid 8910 MAP-3071d TPHI Cost Effective Review Medicare / Dialysis
13 Medicaid 8909 MAP-3071e TPHI CER Fami Policy with Both Exempt and Non-Exempt from MC
13 Medicaid 8908 MAP-3071f TPHI Cost Effective Review Case Synopsis
13 Medicaid 8929 MAP-3072 Aida Health Insurance Program or MA Savings Program
13 Medicaid 8960 MAP-3072(b) Notice of Discontinuance: MSP (SCC)
13 Medicaid 8962 MAP-3074 Medicaid Recertification
13 Medicaid 8933 MAP-3075 Notice of Deferral for HX Referrals
13 Medicaid 8964 MAP-3075a Notice of Deferral (Former Foster Care)
13 Medicaid 9091 MAP-3077 Nursing Home Nauto Transmittal
13 Medicaid 8965 MAP-3078 NHED Transmittal to MICSA FH Unit
13 Medicaid 8974 MAP-3079a Request For Documentation (Quality Control Unit)
13 Medicaid 8975 MAP-3079b Resources Explanation Sheet (Addendum)
13 Medicaid 8971 MAP-3081 Notice of Acceptance of Your Medical Assistance Application
13 Medicaid 8972 MAP-3081a Notice of Change to Your Medical Assistance Coverage
13 Medicaid 8976 MAP-3083 Fair Hearing Information System Transmittal
13 Medicaid 8967 MAP-3084 Transmittal Addendum: Magi/Non-Magi Sort
13 Medicaid 8958 MAP-3085 Medicaid Corrective Action
13 Medicaid 9110 MAP-3086 Applying at the Marketplace
13 Medicaid 8979 MAP-3087 Denial of Your Application for Public Health Insurance (DA)
13 Medicaid 8980 MAP-3087A Denial of Your Application for Public Health Insurance
13 Medicaid 8985 MAP-3089a Notice to Restrict you to a Primary Medicaid Provider
13 Medicaid 7201 MAP-316 Fair Hearing Decision Notice
13 Medicaid 7199 MAP-316A Fair Hearing Notice Accept Family Health Plus Application
13 Medicaid 7202 MAP-316B Fair Hearing Notice Of Denial Of Medicaid/FHP
13 Medicaid 7203 MAP-316C Fair Hearing Plan Selection Notice
13 Medicaid 7204 MAP-316D Notice Of Use Of Old Excess Income (Surplus) Amount
13 Medicaid 7210 MAP-316E Notice Of Retroactive Eligibility
13 Medicaid 7211 MAP-316F Pre-Fair Hearing Summary
13 Medicaid 7200 MAP-316G Fair Hearing Compliance Follow-Up Notice
13 Medicaid 7489 MAP-316H Response To Rivera Request
13 Medicaid 7490 MAP-316J Rivera Request Receipt/Intake
13 Medicaid 8690 MAP-316k Notice to Re-Establish Medicaid
13 Medicaid 7969 MAP-316P Withdrawal of NYS OTDA Fair Hearing Request
13 Medicaid 7841 MAP-316Q Carfare Reimbursement Request FH
13 Medicaid 9072 MAP-316r Fair Hearing Compliance Notice
13 Medicaid 5472 MAP-403 Medicaid Elig Deter-Request for Additional Information
13 Medicaid 5600 MAP-403B Hospital Response to Request for Additional Info.
13 Medicaid 7063 MAP-404 Notice of Non Payment of Your TPHI Premium Discontinuance
13 Medicaid 8893 MAP-404a Non-payment of Your Third Party Health Insurance Premium
13 Medicaid 7205 MAP-404A TPD Document/Info Req. For Health Insurance Premium Paymnts
13 Medicaid 7492 MAP-404B Certificate Of Group Health Plan Coverage
13 Medicaid 8899 MAP-404c Notice of Insufficient Documentation
13 Medicaid 8919 MAP-404d Notice of Health Insurance Confirmation
13 Medicaid 8379 MAP-404e Notice of Removal of Third Party Health Insurance
13 Medicaid 8118 MAP-404F Social Security Administration Referral Form
13 Medicaid 8894 MAP-404g Request to Remove Commercial TPHI
13 Medicaid 8918 MAP-404h Letter for Third Party Health Insurance Premium Reimbursement
13 Medicaid 8961 MAP-404i Statement of Private Insurance
13 Medicaid 8932 MAP-404j NON-Payment of Your Third Party Health Insurance Premium
13 Medicaid 8963 MAP-404k Statement of Private Insurance (2nd Request)
13 Medicaid 6308 MAP-411 Notice of Medicaid Review Team
13 Medicaid 5630 MAP-418R Request for Nursing Home Care/Heath-Related
13 Medicaid 8396 MAP-480C Hospital Request to Lift Medicaid Managed Care
13 Medicaid 8398 MAP-480V Request for Institutions for Mental Diseases-MD Disenrollment
13 Medicaid 7834 MAP-480X Request for SSI/SSI-Related Newborn Disenrollment
13 Medicaid 8643 MAP-5018 Self-Declaration of Income
13 Medicaid 8674 MAP-555 Notice of Intent to Discontinue Health Insurance Coverage (QC)
13 Medicaid 6881 MAP-570A Decision on Your Family Planning Benefit App.(Accept)
13 Medicaid 7356 MAP-570B Decision Notice On MA Application (Family Planning Accept.)
13 Medicaid 7357 MAP-570C (E-S) Minors Declaration Of Age (Family Planning Benefit)
13 Medicaid 6882 MAP-570F Declination of Evaluation for Family Planning Benefit Prog
13 Medicaid 7358 MAP-570G Decision Notice On Family Planning Benefit Only App. Denial
13 Medicaid 7213 MAP-570J Family Planning Benefit Prog. (FPBP) Renewal
13 Medicaid 7573 MAP-58f Facilitated Enrollment Sites
13 Medicaid 8131 MAP-58j List of Facilitated Enrollers and Medicaid Renewal Site
13 Medicaid 6875 MAP-628 Single Item Checklist
13 Medicaid 6832 MAP-628A Mail Renewal Checklist
13 Medicaid 6833 MAP-628B Mail Renewal Case Status Update Sheet
13 Medicaid 7030 MAP-628C MBI-WPD Documentation Checklist
13 Medicaid 7392 MAP-628F Resource Checklist For Long-Term Care Upgrade
13 Medicaid 8112 MAP-628K FERU Case Action Review Checklist
13 Medicaid 8404 MAP-635 Notice of Deferral/Separate Determination
13 Medicaid 7897 MAP-635A Child Health Referral
13 Medicaid 7491 MAP-635b Referral to Investigation Revenue and Enforcement Admin-IREA
13 Medicaid 7049 MAP-635D Referral to Child Support Enforcement Unit CSEU
13 Medicaid 7522 MAP-635G MSP Referral For Correct Documentation From SSA
13 Medicaid 7520 MAP-635H (ES) Non Public Assistance Food Stamp Appointment Notice
13 Medicaid 7560 MAP-635J Medicaid/Family Health Plus Renewal
13 Medicaid 8032 MAP-635K Notice of Deferral (Application)
13 Medicaid 7527 MAP-635M Conference Unit Client Referral
13 Medicaid 7528 MAP-635N Notice of Deferral Pooled Trust
13 Medicaid 8033 MAP-635Q Notice if Second Deferral (Application)
13 Medicaid 8419 MAP-635S Notice of Deferral
13 Medicaid 8481 MAP-635U Mail Renewal Reminder (PTM for FHPlus)
13 Medicaid 9055 MAP-635W Notice of Deferral
13 Medicaid 9113 MAP-647j Hospital Inpatient Transmittal
13 Medicaid 8787 MAP-647W Transmittal of Enrollment Status for CHP Applicants
13 Medicaid 8056 MAP-648E Pooled Trust Case Transmittal
13 Medicaid 7894 MAP-648M Inter-Agency (DOS) and (DEC) Transmittal Form
13 Medicaid 7842 MAP-648p Receipt for Submission from Residential Healthcare Facilities
13 Medicaid 8645 MAP-648r Substantial Home Equity Referral
13 Medicaid 8261 MAP-648S Match Information for Consumers Born in Puerto Rico
13 Medicaid 7369 MAP-649G CHP B Managed Care Enrollment Transmittal
13 Medicaid 7225 MAP-649K NHED NAMI Reporting Transmittal
13 Medicaid 7226 MAP-649L MLTC Disenrollment Reporting Transmittal
13 Medicaid 7224 MAP-649U Fair Hearing Transmittal To Reimbursement Unit
13 Medicaid 8111 MAP-700 Medicaid Case Action Review Worksheet
13 Medicaid 7826 MAP-713 Notice of Acceptance of Your Medical Assistance Application
13 Medicaid 7827 MAP-713A Notice of Change To Your Medical Assistance Coverage
13 Medicaid 7828 MAP-713B Notice of Change To Your Medical Assistance Coverage
13 Medicaid 7829 MAP-713C Notice of Discontinuance of Medical Assistance Coverage
13 Medicaid 7830 MAP-713D Notice of Discontinuance of Medical Assistance Coverage
13 Medicaid 7831 MAP-713E Notice of Discontinuance of Medical Assistance Coverage
13 Medicaid 7832 MAP-713F Notice of Discontinuance of Medical Assistance Coverage
13 Medicaid 8117 MAP-713G Discontinuance of Medicaid Coverage S/CC
13 Medicaid 8084 MAP-713H No Longer Meets the Medical Improvement Group Requirements FP
13 Medicaid 8085 MAP-713J No Longer Meets the Medical Improvement Group Requirements
13 Medicaid 8086 MAP-713K MBI-WPD Medical Improvement Group
13 Medicaid 8087 MAP-713M Under the MBI-WPD Medical Improvement Group (Work/Wage-FNP
13 Medicaid 8115 MAP-713N Discontinuance of Medicaid Coverage Work/Wage-FP
13 Medicaid 8116 MAP-713P Discontinuance of Medicaid Coverage Work/Wage-S/CC
13 Medicaid 5817 MAP-751 Hospital Request to Change Client Information on File
13 Medicaid 6883 MAP-751A Provider Request to Change Client Information On File
13 Medicaid 7042 MAP-751B Consumer Request To Change Address/Telephone Number
13 Medicaid 6874 MAP-751C Request Access Medicaid Info/Exercise HIPAA Privacy Rights
13 Medicaid 8522 MAP-751c Request for Health Insurance Information
13 Medicaid 6873 MAP-751D Disclosure Authorization Of Individual Health Information
13 Medicaid 6935 MAP-751E Authorization to Release Medical Information
13 Medicaid 6936 MAP-751F Authorization for Release of Confidential HIV Related Info
13 Medicaid 7208 MAP-751G Response To Consumer Request For Change
13 Medicaid 8898 MAP-751h Hospital Request for Sex or Date of Birth Correction
13 Medicaid 7319 MAP-751J Feau/Feru Request For Case Correction
13 Medicaid 7895 MAP-751K Consumer Request to Change Information on File
13 Medicaid 7843 MAP-751N Limited Power of Attorney
13 Medicaid 7840 MAP-751P Consent to Release Information
13 Medicaid 7984 MAP-751Q Request to Update Case Records
13 Medicaid 8385 MAP-751u Response to Your Request for Health Insurance Information
13 Medicaid 5423 MAP-779 Authorization to Receive Distribute Medicaid Card
13 Medicaid 7393 MAP-802V Surplus Income Log (Replaces MAP-2069B)
13 Medicaid 7889 MAP-900a Notice of Denial of your Medical Assistance Application
13 Medicaid 8903 MAP-900c Notice of Insufficient Documentation
13 Medicaid 8900 MAP-900d Dispensing Medication (MCCS – Pharmacy Letter)
13 Medicaid 8901 MAP-900e Eligibility Update (MCCS-Provider)
13 Medicaid 8400 MAP-900G Certification of On-Line Renewal
13 Medicaid 8496 MAP-908c Notice of Intent to Discontinue MA (Transitional Medicaid)
13 Medicaid 5581 MAP-909 Notice to Former SSI Beneficiary
13 Medicaid 7227 MAP-909A (E-S) Notice To Former CA Applicant: Schedule MA Interview
13 Medicaid 7228 MAP-909B Notice To Schedule Interview For Medicaid (Closed Cases)
13 Medicaid 7359 MAP-909C (E-S) Notice Schedule MA Interview (Separate Determination)
13 Medicaid 7494 MAP-909E DAB Renewal Notification-Medicaid Managed Long Term Care
13 Medicaid 7672 MAP-909F Medicare Savings Program Renewal Notification
13 Medicaid 5582 MAP-931B Agreement to Participate in the Medicaid Pay-In Program
13 Medicaid 7361 MAP-931D Refund Notice Due 2 Review Of Your MA Claims (Pay-In-Prgrm)
13 Medicaid 7317 MAP-931E Notice Of Review Of MA Claims (Pay-In-Program)
13 Medicaid 6229 MAP-931g Surplus Income Prog Decision Notice Coverage not Auth Pay In
13 Medicaid 6885 MAP-931J How to Apply: MA's Excess Income/Resource Program or FHP
13 Medicaid 7064 MAP-931N Notice of Excess Resources replaces MAP-2159E
13 Medicaid 7212 MAP-931T Explanation Of Your Medicaid Coverage Level (RVI)
13 Medicaid 8109 MAP-931Y Surplus Fax Medical Bills
13 Medicaid 7137 MAP-992C Notice Of Conversion From FHP To MA Excess Income Program
13 Medicaid 7363 MAP-992D Notice Of Conversion From FHP To MA Excess Income Program
13 Medicaid 7364 MAP-992E Notice Of Conversion From FHP To MA Excess Resource Program
13 Medicaid 7136 MAP-992F Notice Of Conversion From Family Health Plus To Medicaid
13 Medicaid 7365 MAP-992G Notice Of Cancellation Of Family Health Plus Coverage
13 Medicaid 8022 MAP-992H Notice of Discontinuance of FH Plus Coverage
13 Medicaid 8042 MAP-992J Notice of Change-Medicaid Income to MBI-WPD
13 Medicaid 8609 MAP-992k Medicaid Excess Income/Resources Program Return Check Notific
13 Medicaid 5709 MAP-HHC On-Site Demo Project Case Tracking Form MAP/E H917
13 Medicaid 7890 MAP-U0177 Notice to Reinstate Medical Assistance Coverage
13 Medicaid 7893 MAP-U0181 Notice to Reinstate Medical Assistance Coverage
13 Medicaid 7891 MAP-U0182 Notice to Reinstate Family Planning Benefit Program
13 Medicaid 5583 MAP/E 2201 Employment History Sheet
13 Medicaid 5856 MAP/E 40036 Documentation Request
13 Medicaid 5710 MAP/E C1080 Medical Assistance Program Community
13 Medicaid 5909 MAP/E C1435 Supervisory Check Off List
13 Medicaid 5858 MAP/E C218A Eligible for Medicare Under Aid to Disabled Program
13 Medicaid 5876 MAP/E C794 Medicaid Documentation Request/Recertification
13 Medicaid 5886 MAP/E C931 Notice of Decision
13 Medicaid 5882 MAP/E C992A Monthly Surplus Decision
13 Medicaid 5584 MAP/E E201 Employ Doc
13 Medicaid 5837 MAP/E E22 We cannot arrive at a decision Request for Information
13 Medicaid 5903 MAP/E E305 Routing/ Referral Slip
13 Medicaid 5674 MAP/E E672 Application Review
13 Medicaid 5842 MAP/E E713 Bank Inquiry and Report
13 Medicaid 5585 MAP/E H 920 Case Submission Sheet
13 Medicaid 5588 MAP/E H403B Request for Additional Information
13 Medicaid 5875 MAP/E H914 MAP-HHC On Site DemoProj notification prior case report
13 Medicaid 5874 MAP/E H921 MAP-HHC On Site DemoProj notification errors to HHC
13 Medicaid 5695 MAP/E H955 Hospital Eligibility Tracking System Referral Form
13 Medicaid 5704 MAP/E Intake Clearance and Control Notice to Former SSI Beneficiary
13 Medicaid 5850 MAP/E L960 Chronic Care Recertification
13 Medicaid 5888 MAP/E MS411 Notice of Determination for Aid to Disabled Category
13 Medicaid 8973 MAP3079 Request For Information (Residential Health Care Facilities)
13 Medicaid 7959 MAPMKB-402-E MKB Notice of Medicaid Determination Form
13 Medicaid 9088 Maximus eligibility documents
13 Medicaid 9061 MAXIMUS FHP Enrollment Form
13 Medicaid 7844 MC Exemption Request Back-File Packet
13 Medicaid 7845 MC Exemption Request Packet
13 Medicaid 5619 Medicaid Documentation Guide
13 Medicaid 5821 Medicaid Recertification
13 Medicaid 5776 Medicaid Resource History
13 Medicaid 8473 Medicaid Wavier (any kind)
13 Medicaid 8931 Medical Assistance Payment of Medicare Part A and/or Part B Premium
13 Medicaid 6222 Medical Assistance Program Verification Guide
13 Medicaid 5752 Medical Assistance Questionnaire Responsible Relative
13 Medicaid 5594 Medical Eligibility Program Letter -If we do not hear from you within 2 weeks
13 Medicaid 7215 Medical Records
13 Medicaid 5526 Medicare Buy-In Deletion Transmittal
13 Medicaid 5813 Medicare Buy-in Request for Active Medicaid Recipients
13 Medicaid 5595 MEP 2105A In Request for Information Concerning Your Income
13 Medicaid 5879 MEP 2127A Medicaid Home Care Control Card
13 Medicaid 6343 MEP-205 Transmittal for Health Maintenance Organizations - Enrollments
13 Medicaid 5871 MEP-2080 Institutional Services Control Form
13 Medicaid 5593 MEP-2105A HR Human Resource Administration Medicaid Elig Program
13 Medicaid 5686 MEP-2158A Dear Health Care Provider Letter
13 Medicaid 5598 MEP-2159F Medicare Optimization
13 Medicaid 5681 MEP-2162A Client Data Form Household Information
13 Medicaid 5914 MEP-2162D Transmittal for Medicaid Eligibility for Pregnant Women
13 Medicaid 5601 MEP-403B Add Request for Additional Information
13 Medicaid 5508 MEP-418R Request for Medical Assistance
13 Medicaid 5602 MEP-649 Transmittal to Medicaid Eligibility Program
13 Medicaid 6178 MIC Appointment Book
13 Medicaid 9035 MICSA SSA Eligibility Response
13 Medicaid 7850 MKB Medicaid Retroactive Relief Packet
13 Medicaid 6489 MRT Plan of Care
13 Medicaid 8703 MSP Conversion For MLTC Enrollment
13 Medicaid 8572 Neurology Lab
13 Medicaid 5625 New York Hospital Based Certification for an Application for Medical Assistance
13 Medicaid 8664 NHD Budget Revision Letter
13 Medicaid 8141 NHD Legal Referral Packet
13 Medicaid 5884 Notice of Action on Application Benefit for the Medicaid Buy-in Progr
13 Medicaid 5788 Notice of Appointment for Consultive Examination
13 Medicaid 5798 Notice of Change in Hospital Care Liability
13 Medicaid 8474 Notice of Decision for FHP – Premium Assistance
13 Medicaid 5627 Notice of Decision on Your Medical Assistance
13 Medicaid 8171 Notice of Decision to Discontinue Your Medical Assistance
13 Medicaid 5624 Notice of Determination of Non-Entitlement to Benefits
13 Medicaid 5758 Notice of Eligibility/Recertification for Medicaid
13 Medicaid 8785 Notice of MA Disability Determination – MBI-WPD Basic Group
13 Medicaid 5822 Notice of Medicaid Recertification
13 Medicaid 5891 Notice of Reduction Discontinuance Receipt of Social Security Benefit
13 Medicaid 5892 Notice Requirement to Provide Documents-Resources at Recertification
13 Medicaid 5767 Notice to Patient Accounts Staff Regarding Disposition of Corresponded
13 Medicaid 5814 Notification of Change or Correction to File from RHCF
13 Medicaid 5783 Notification of Pending Personal Injury or Negligence Law Suit
13 Medicaid 7971 NYC Department of Corrections DOC Inmate Identification Card
13 Medicaid 8707 NYS DOH Medicaid Service Coordination Notice
13 Medicaid 7507 NYS DOH Recipient Demographic Report RRP
13 Medicaid 8602 NYS DOH-4287 Continuing Your Medicaid or Family Health plus Benefits
13 Medicaid 6423 NYS Medicaid Eligibility Current Record Report
13 Medicaid 8412 NYS Worker’s Compensation Board – Medical exam form
13 Medicaid 8402 NYSDOH-435 Discontinue the Care at Home I and II Waiver NYC-Only
13 Medicaid 9050 NYSDOH-CAH Change of Case Management
13 Medicaid 9048 NYSDOH-CAH Choice of Care
13 Medicaid 9051 NYSDOH-HX Referral
13 Medicaid 9049 NYSDOH-MA Waiver CAH I & II Application
13 Medicaid 8573 Obstetrics/Gynecology Lab
13 Medicaid 6618 Office of Medicaid Management Newborn Input Form or Worksheet
13 Medicaid 9041 OHIP-0005 Childhood Medical Disability Report
13 Medicaid 9042 OHIP-0006 Questionnaire of School Performance
13 Medicaid 9043 OHIP-0007 Description of Child Activities
13 Medicaid 9104 OHIP-0012 Eligibility for Children Screening Determination Letter
13 Medicaid 8169 OHIP-0035 NYC Medicaid Part D
13 Medicaid 8472 OHIP-0044 Denial for the Medicare Savings Program (SSA)
13 Medicaid 8959 OHIP-0052 Regarding Payment of Third Party Heath Insurance Premiums
13 Medicaid 8923 OHIP-0069NYC Applying for Medicaid Benefits
13 Medicaid 9105 OHIP-4441 Medicaid Eligibility For Children Screening Form
13 Medicaid 8502 OLA / Attorney Correspondence
13 Medicaid 8142 OLA Legal Recommendation
13 Medicaid 8567 Orthopedics Lab
13 Medicaid 8571 Other Specialty Lab
13 Medicaid 6113 Out-patient referral for admission to wards
13 Medicaid 8654 Personal Care Services Contract
13 Medicaid 8499 Petition for Pooled Trust
13 Medicaid 8577 Physiatry Lab
13 Medicaid 8836 PIMM Communications Deferral Alert
13 Medicaid 8500 Pooled Trust
13 Medicaid 8501 Pooled Trust Deposits
13 Medicaid 9021 Premium Assit Medicare Saving Program
13 Medicaid 5826 Program Referral
13 Medicaid 8628 Promissory Note
13 Medicaid 8574 Psychiatry Lab
13 Medicaid 8570 Pulmonology Lab
13 Medicaid 5896 Quality Control Workbook Face Sheet
13 Medicaid 5902 Raquest to Accept a Medicaid Application for a PA Case Denial Closed
13 Medicaid 5626 Reason for Application or Past Maintenance or Supplemental Information
13 Medicaid 5897 Reason for Application Past Maintenance Supplemental Information
13 Medicaid 5829 Reassessment Center Referral Letter
13 Medicaid 5497 Recertification Guide for the Medical Assistance Face to Face Interview
13 Medicaid 5498 Recertification Statement
13 Medicaid 5499 Recertification Statement Continued Medicaid Coverage for Newborn Babies
13 Medicaid 7506 Recipient Detail Request Report RRP
13 Medicaid 5835 Referral for Medicaid or Home Care Services
13 Medicaid 6497 Registered Nurse's Certification
13 Medicaid 5622 Release of Confirmation Statement and Uniform Assignment
13 Medicaid 8413 Relocation Referral Notice
13 Medicaid 5778 Reminder of Recertification Appointment
13 Medicaid 5617 Report of BEV Applicant Recommendation
13 Medicaid 8897 Request for a Deferral Extension (MICSA)
13 Medicaid 5503 Request for Additional Information Medicaid
13 Medicaid 5750 Request for Compliance
13 Medicaid 5786 Request for Documentation or Information for Recertification
13 Medicaid 5881 Request for Employee Benefits Information
13 Medicaid 6498 Request for Exception Receive Personal Care Services Physician's Cert
13 Medicaid 5811 Request for Financial Assessment
13 Medicaid 5802 Request for Long Term Care
13 Medicaid 5901 Request for New Physician's Statement of Determination of Disability
13 Medicaid 9074 Resident Expense Statement
13 Medicaid 8575 Rheumatology Lab
13 Medicaid 5801 Scheduled Appointments for SACC Assessments
13 Medicaid 7939 Self attestation for Rikers Inmates
13 Medicaid 5730 Single Item Collection Division of Accounts Receivable and Billing
13 Medicaid 5741 Social Statement for Determination of Disability
13 Medicaid 8545 Specialty Medical Obstetrics/Gynecology (16AO)
13 Medicaid 8559 Specialty Medical Obstetrics/Gynecology (96AO)
13 Medicaid 8536 Specialty Medical Cardiology (16AC)
13 Medicaid 8550 Specialty Medical Cardiology (96AC)
13 Medicaid 8537 Specialty Medical Dermatology (16AD)
13 Medicaid 8551 Specialty Medical Dermatology (96AD)
13 Medicaid 8538 Specialty Medical Endocrinology (16AE)
13 Medicaid 8552 Specialty Medical Endocrinology (96AE)
13 Medicaid 8540 Specialty Medical Gastroenterology (16AG)
13 Medicaid 8554 Specialty Medical Gastroenterology (96AG)
13 Medicaid 8548 Specialty Medical General Surgery (16AS)
13 Medicaid 8562 Specialty Medical General Surgery (96AS)
13 Medicaid 8541 Specialty Medical Hematology/Oncology (16AH)
13 Medicaid 8555 Specialty Medical Hematology/Oncology (96AH)
13 Medicaid 8544 Specialty Medical Neurology (16AN)
13 Medicaid 8558 Specialty Medical Neurology (96AN)
13 Medicaid 8539 Specialty Medical Orthopedics (16AF)
13 Medicaid 8553 Specialty Medical Orthopedics (96AF)
13 Medicaid 8543 Specialty Medical Other Specialty (16AM)
13 Medicaid 8557 Specialty Medical Other Specialty (96AM)
13 Medicaid 8549 Specialty Medical Physiatry (16AT)
13 Medicaid 8563 Specialty Medical Physiatry (96AT)
13 Medicaid 8546 Specialty Medical Psychiatry (16AP)
13 Medicaid 8560 Specialty Medical Psychiatry (96AP)
13 Medicaid 8542 Specialty Medical Pulmonology (16AL)
13 Medicaid 8556 Specialty Medical Pulmonology (96AL)
13 Medicaid 8547 Specialty Medical Rheumatology (16AR)
13 Medicaid 8561 Specialty Medical Rheumatology (96AR)
13 Medicaid 5603 SSA - Application for a Social Security Card
13 Medicaid 8789 SSA ERE Document
13 Medicaid 5629 SSA-1099 SM Social Security Benefit Statement
13 Medicaid 5906 SSA-1099 Social Security Benefit Statement
13 Medicaid 7792 SSA-16 Application for Disability Insurance Benefits
13 Medicaid 5605 SSA-2458 Report of Confidential Social Security Benefit Information
13 Medicaid 6575 SSA-3199-SM Your Medicare Premium Refund
13 Medicaid 6411 SSA-3368-BK Part II Information About Your Medical Records
13 Medicaid 6201 SSA-3368-F6 Disability Report
13 Medicaid 9034 SSA-3911 MICSA SSA Eligibility Referral
13 Medicaid 8164 SSA-4814-F5 Medical Report on Adult with Allegation of HIV Infection
13 Medicaid 8165 SSA-4815-F6 Medical Report on Child with Allegation of HIV Infection
13 Medicaid 5913 SSA-491TC TPQY Input
13 Medicaid 5606 SSA-4926 SM SSA How we figured your new appointment amount
13 Medicaid 5658 SSA-7028 Third Party of Social Security Number-Notice to
13 Medicaid 5645 SSA-L30 SSA Retire Survivors and Disability Insurance Notice of Award
13 Medicaid 5652 SSA-L30-CI Social Security Award Certificate
13 Medicaid 6570 SSA-L444 Supplemental Security Income Notice
13 Medicaid 8705 SSA-L8125 SSI Notice of Interim Assistance Reimbursement
13 Medicaid 5607 SSAL8025 SSA Supplemental Security Income Notice of Award
13 Medicaid 8414 State Medicaid Verification
13 Medicaid 5791 Statement of Medicaid Authorization and Surplus Income
13 Medicaid 5745 Sterilization Consent Form
13 Medicaid 8581 Supp DVE (16SD)
13 Medicaid 8122 Supplement Needs Trust - OLA Correspondence
13 Medicaid 6869 Supplemental Info Office of Children and Family Services' Youth
13 Medicaid 8585 Surplus E-Fax Packet
13 Medicaid 8389 Third Part - MSP Referral
13 Medicaid 8387 Third Party - NFA Request
13 Medicaid 8388 Third Party - Request ready for processing
13 Medicaid 5747 Third Party Health Insurance Data Entry Form
13 Medicaid 8193 Third Party Packet
13 Medicaid 5789 Transmittal for Medicaid Community Care/New Applications
13 Medicaid 5815 Transmittal for Presumptive Medicaid Eligibility for Pregnant Women
13 Medicaid 8873 VISA Verification (MICSA only)
13 Medicaid 5673 W- Application for Short Term Home Relief Child Hospitalized Beyond
13 Medicaid 5728 W-132N Referral to Medicaid Office from Job Center
13 Medicaid 6050 W-132P Income Support Program Dear Medicaid Recipient.
13 Medicaid 7496 W-148A Authorization PA Reimbursement f or SSI Retroactive Paymnt
13 Medicaid 5670 W-180F Administration for Children's Services
13 Medicaid 5647 W-180G Hospital Home Relief Notice
13 Medicaid 5613 W-2-112 As a MA Claiment u r allowed to establish a Burial Fund
13 Medicaid 5608 W-296E Medicaid Recertification
13 Medicaid 5474 W-296N Medicaid Recertification
13 Medicaid 6189 W-34D B-M-A Referral Form
13 Medicaid 5682 W-435 Code 4A Registry Transmittal
13 Medicaid 6495 W-441 PERS Installation Removal or Re-Installation Transmittal
13 Medicaid 6436 W-477D Medicaid Managed Health Care Program Enrollment
13 Medicaid 8792 W-480D Uniform Request to add Unborns to Managed Care Cases
13 Medicaid 6781 W-480F Undercare Managed Care Benefit Code or Case Number Change
13 Medicaid 6771 W-480G Managed Care Enrollment Transmittal
13 Medicaid 7324 W-480Q Hosp. Req to Lift Managed Care Enroll Serv. During Elig. Gap
13 Medicaid 5614 W-506 Real Property Information
13 Medicaid 5715 W-560 Notice of Approval of Second Transition and Medicaid Extension
13 Medicaid 5877 W-586K Medicaid Field Investigation Report
13 Medicaid 5611 W-589 Acc Account Information-Request
13 Medicaid 5885 W-589C Notice of Continuation of your Medical Assistance Coverage
13 Medicaid 5677 W-663B Authorization for Medical Assistance
13 Medicaid 5862 W-663B Batch Transmittal MAP 2064
13 Medicaid 6202 W-694 DSS-515 Addendum
13 Medicaid 6251 W-884 Special Exceptional Care Authorization
13 Medicaid 6223 W-8848 Medical or Psychiatric Certification
13 Medicaid 7399 W-930 HomeCare Services Program CASA Control Form
13 Medicaid 8833 W2 Correspondence Letter
13 Medicaid 5772 WARNRPT RPT Long term Home Health Care System rejects By Vendor ID
13 Medicaid 5592 Welfare Public Assistance - Welfare Reform
13 Medicaid 8578 Wellness Plan Extension
13 Medicaid 6177 WIC Appointment Book
13 Medicaid 5522 WINRO 728 Case Eligibility Review Document CERD
13 Medicaid 5942 Work Readiness
13 Medicaid 5618 Worker Checklist for Medical Assistance
13 Medicaid 5615 XL-0218 Decision on Your Medical Assistance-Notice of
14 RAU 6857 RAU Movers Inventory List
14 RAU 7956 RAU Packet
14 RAU 6853 RAU Special Factors or Correspondences
14 RAU 6862 RAU Three Estimates from Licensed Movers
14 RAU 6855 RAU Unified Court System printout
14 RAU 6858 RAU W-145N Request for Emergency Assistance
14 RAU 6859 RAU W-146E Excess Rent & Third Party Proof of Income
14 RAU 6861 RAU W-147BB Request for Approval of Special Grant 22
14 RAU 6854 RAU W-153Q Notice Of Approval On The Request To Rental Assistance Unit
14 RAU 6856 RAU W-153T Notice Of Denial On The Request To The Rental Assistance
14 RAU 6860 RAU WMS Printout
14 RAU 7594 W-150R APS Rental Assistance Unit Exception to Policy Request
15 BEV 7272 BEV Employment Business Records
15 BEV 7269 BEV Employment Current Wage Stubs
15 BEV 7271 BEV Employment Employer Verification
15 BEV 7268 BEV Employment Pay Envelopes
15 BEV 7266 BEV Employment Pay Stubs
15 BEV 7267 BEV Employment Tax Returns submitted by client
15 BEV 7270 BEV Employment/Income Unemployment UIB
15 BEV 7249 BEV Identity Adoption Papers/Records
15 BEV 7250 BEV Identity Birth Certificate or Baptismal Records
15 BEV 7252 BEV Identity Death Certificate
15 BEV 7245 BEV Identity Driver's License
15 BEV 7248 BEV Identity Hospital or Doctor's Records
15 BEV 7247 BEV Identity Naturalization Certificate
15 BEV 7253 BEV Identity Official Correspondence from SSA
15 BEV 7255 BEV Identity Other
15 BEV 7246 BEV Identity Passport
15 BEV 7385 BEV Identity Permanent Resident Card
15 BEV 7244 BEV Identity Photo ID
15 BEV 7251 BEV Identity Social Security Card or DSS-400
15 BEV 7254 BEV Identity VA or Military Records
15 BEV 7259 BEV Marital Status Court Records
15 BEV 7258 BEV Marital Status Divorce Decree
15 BEV 7256 BEV Marital Status Marriage or Death Certificates
15 BEV 7386 BEV Marital Status Other
15 BEV 7257 BEV Marital Status Separation Agreement
15 BEV 7281 BEV Notebook ALERTS
15 BEV 7261 BEV Residence Current Rent Receipt or Lease
15 BEV 7263 BEV Residence Driver's Registration
15 BEV 7265 BEV Residence Mortgage Records or Bank Statement
15 BEV 7388 BEV Residence Other
15 BEV 7260 BEV Residence School Records
15 BEV 7262 BEV Residence Statement from Landlord
15 BEV 7277 BEV Resources Burial plot deed
15 BEV 7273 BEV Resources Current bank or credit union records
15 BEV 7279 BEV Resources Deed
15 BEV 7276 BEV Resources Insurance policy
15 BEV 7391 BEV Resources Other
15 BEV 7275 BEV Resources Statement from financial institution
15 BEV 7278 BEV Resources Statement from funeral director
15 BEV 7274 BEV Resources Stock or Bond certificate
15 BEV 7280 BEV Resources Tax Refund or EITC check
15 BEV 6376 BEV W-585G Notice to Telephone BEV
15 BEV 6377 BEV W-585K BEV Interview and Recommendation Worksheet
15 BEV 7107 BEV W-585P or BEV 30 BEV Client Address Info Request Letter
15 BEV 7484 BEV W-585Z Withdrawal of Application
15 BEV 6737 BEV W-586F BEV-FA Undercare or Applicant Child Verification Ins
15 BEV 7110 BEV W-588D BEV recommendation Application or Undercare data entry
15 BEV 7485 BEV W-592G Employment or Wages Verification
15 BEV 7367 BEV W-593H Appendix B ALERTS-Application
15 BEV 7368 BEV W-593J Appendix B 1 ALERTS-Application
15 BEV 5199 BEV- W-532T Eligibility Verification Review Questionnaire
15 BEV 8308 BEV-100 Notice Real Property Ownership Appointment
15 BEV 9039 BEV-100m Disposition on Income Producing Property
15 BEV 9040 BEV-100r Household Budget Calculation Sheet
15 BEV 8978 BEV-200A Notice of Referral to Bureau of Eligibility Verification
15 BEV 8815 BEV-230 SNAP Front End Detection System Request for Information
15 BEV 5367 BEV-W-585R BEV Investigative Notes
15 BEV 5952 W-532DD FA Eligibility Verification Review BEV EVR Question
15 BEV 6120 W-585B Notice of Compliance with BEV Appointment
15 BEV 6013 W-585W BEV Not at Home Notice
16 Home Visit/Homebound Documentation 8679 ADA Compliance Officer Appeal Decision Letter
16 Home Visit/Homebound Documentation 8317 CAS-101 Authoization for Release of Health Info Pursuant to HIPAA
16 Home Visit/Homebound Documentation 8335 CAS-102 Activities of Daily Living
16 Home Visit/Homebound Documentation 8336 CAS-103 Physician’s Assessment Form
16 Home Visit/Homebound Documentation 8584 CAS-104 Home Visit Needed Request Reviewer Outcome Form
16 Home Visit/Homebound Documentation 8344 CAS-300 Medical Provider Appointment WeCare Referral for Assessment
16 Home Visit/Homebound Documentation 8411 CAS-311 Home Visit Needed Assessment Cancellation (We Care)
16 Home Visit/Homebound Documentation 8591 CAS-316 New Service Provider WeCare Program
16 Home Visit/Homebound Documentation 8318 FIA-1028a Notification of Home Visit Needed/Homebound Status Determine
16 Home Visit/Homebound Documentation 8319 FIA-1028b Home Visit Appointment Notice (Cash Assistance Application)
16 Home Visit/Homebound Documentation 8320 FIA-1028c Mandatory Appointment Notice for NCA Food Stamp Application
16 Home Visit/Homebound Documentation 8321 FIA-1028d Request to Remove Home Visit Needed/Homebound Status
16 Home Visit/Homebound Documentation 8322 FIA-1028e Notice of Removal of Home Visit Needed/Homebound Status
16 Home Visit/Homebound Documentation 8323 FIA-1028f Refusal of Cash Assistance App/Recert/Home Visit Appointment
16 Home Visit/Homebound Documentation 8488 FIA-1028h Notice of Scheduled Home Visit
16 Home Visit/Homebound Documentation 8490 FIA-1028i Documentation Request for Home Visits Homebound
16 Home Visit/Homebound Documentation 8802 FIA-1028j Notice to Individuals Requesting Home Visit Needed HVN/HB
16 Home Visit/Homebound Documentation 8489 FIA-1028k Notification of Expiration of Home Visit Homebound
16 Home Visit/Homebound Documentation 8800 FIA-1028L Liaison Checklist of Required Documents for CAS Review
16 Home Visit/Homebound Documentation 8714 FIA-1086f Referral to Back to Work (B2W) Vendor
16 Home Visit/Homebound Documentation 8316 Home Visit Needed/Homebound Status Documentation
16 Home Visit/Homebound Documentation 8334 HRA-102 Request for Appeal of Reasonable Accommodation Determination
16 Home Visit/Homebound Documentation 8655 HRA-102a Reasonable Accommodation Request (RAR) Form
16 Home Visit/Homebound Documentation 8656 HRA-102b RAR Conformation Notice
16 Home Visit/Homebound Documentation 8619 HRA-104 Determination of Your Reasonable Accommodation Request
16 Home Visit/Homebound Documentation 8620 HRA-105 Denial of Reasonable Accommodation No Medical Documentation
16 Home Visit/Homebound Documentation 8791 HRA-108 HIPPA Authorization for Disclosure of Health Info
16 Home Visit/Homebound Documentation 7578 Other Proof of Homebound Status
16 Home Visit/Homebound Documentation 8657 RAR Medical Documentation
02 Housing Information 6714 "NYCHA History Sheet Telephone Review
02 Housing Information 8172 "W-590BB Compliance with Real Property Assets Unit
02 Housing Information 8173 "W-590DD Failure to Cooperate with Revenue Enforcement Administration
02 Housing Information 6715 1900 Rent Arrears Request
02 Housing Information 6680 Arrears Settlement or DVP Request Form
02 Housing Information 6735 Broker's Fee Voucher -Memo
02 Housing Information 5818 Calculation of Rent - any document showing how the rent is calculated
02 Housing Information 6734 Certification of Rent Payment - Memo
02 Housing Information 0268 Clinic Card Immunization Record with Current Address
02 Housing Information 7190 CM-621c Worksheet For Computing Special Grant Housing Subsidy
02 Housing Information 7191 CM-621f Notice to Landlord of Monthly Rent Subsidy
02 Housing Information 6731 Co-op Buy in Fees Statement from Co-op Sponsor
02 Housing Information 8668 Copy of Broker’s License
02 Housing Information 7295 Copy of money order for contribution toward rent arrears
02 Housing Information 5362 Copy of Rent Payment Check
02 Housing Information 7287 Court-ordered Stipulation with LT or Index Number (rent arrears)
02 Housing Information 0328 Current Lease
02 Housing Information 6820 Current Mail w current address need one add'l document
02 Housing Information 0288 Current Rent Receipt
02 Housing Information 0260 Current Report Card
02 Housing Information 0256 Current School Letter with Current Address
02 Housing Information 0304 Deed to home
02 Housing Information 1036 DHS Referral to Income Support Center
02 Housing Information 0320 Documentation of Future Ability to Pay Housing Expenses
02 Housing Information 8669 Documentation of SCRIE or DRIE in effect to freeze rent level
02 Housing Information 8670 Documentation of SCRIE or DRIE pending applications
02 Housing Information 7289 Eviction Notice
02 Housing Information 6605 FHC-245 R1 NYC Dept. of HPD voucher or Cert Section 8 Subsidy
02 Housing Information 8302 FIA-1010 Corrective Measures Initiated
02 Housing Information 8300 FIA-1017 Notice of Decision on Security Voucher Claim
02 Housing Information 8477 FIA-1037 Assignment of Security Deposit
02 Housing Information 8478 FIA-1038 Acknowledgment of Assignment of Security Deposit
02 Housing Information 6723 Heating Benefit Calculation Worksheet
02 Housing Information 0308 Home Insurance Policy
02 Housing Information 6733 Homeless Prevention Legal Services/Request Re-Review EAF Certification
02 Housing Information 0284 Hotel Receipt
02 Housing Information 8293 Housing Package/Documentation HASA
02 Housing Information 7409 HPD Rent Subsidies Recertification Declaration Form
02 Housing Information 6682 HPD TAS Office of Property Management Printout
02 Housing Information 6681 HPD Three Day Notice
02 Housing Information 7222 HSP Apartment Acceptance Form
02 Housing Information 7219 HSP Ineligibility Form
02 Housing Information 7223 HSP Inspection Checklist
02 Housing Information 7220 HSP Landlord's Statement
02 Housing Information 7221 HSP Lease Rider
02 Housing Information 8471 HUD Lease Addendum
02 Housing Information 0276 Landlord Letter Statement from Non-Relative Landlord
02 Housing Information 0324 Landlord Notice Court Document
02 Housing Information 0286 Letter from Facility
02 Housing Information 7185 Letter Seeking contribution for Rent Arrears
02 Housing Information 9087 LINC Packet
02 Housing Information 6194 MAP 1124A Clients Intent to Return Home
02 Housing Information 7290 Marshall Notice
02 Housing Information 0300 Mortgage Statement Receipt
02 Housing Information 7294 Nonprofit Org official letterhead stating contribution toward arrears
02 Housing Information 7288 Notice of Petition rent arrears
02 Housing Information 9030 Notice to Landlord
02 Housing Information 6695 Notice to Landlord of Two-Party Check Correction
02 Housing Information 9029 Notice to Tenant
02 Housing Information 6607 NYCHA - Section 8 Existing housing Program
02 Housing Information 0292 NYCHA Rent Book Letter from Housing Manager
02 Housing Information 6711 NYCHA Worksheet for Re-Housed Hotel or Shelter Cases
02 Housing Information 7316 NYS OTDA FEPS Approval Letter
02 Housing Information 8258 ODVEIS-1 Advantage Program Continuation Appointment
02 Housing Information 8356 ODVEIS-3 Advantage Rental Supplement Appointment
02 Housing Information 8363 ODVEIS-6 Advantage Program Continuation Decision Notice
02 Housing Information 8362 ODVEIS-7 Advantage Program Continuation Approval Notice
02 Housing Information 8361 ODVEIS-8 Advantage Program Continuation Deferral Notice
02 Housing Information 8364 ODVEIS-9 Advantage Program Continuation Denial Notice
02 Housing Information 8267 ODVEIS-IdE Advantage Program Continuation Denial Notice
02 Housing Information 6616 Office of Community Services Referral - Leased Housing Match
02 Housing Information 6617 Office of Community Services Referral - Section 8 Referral
02 Housing Information 7291 Order to Show Cause rent arrears
02 Housing Information 1692 Other Acceptable Document detailing housing related benefits
02 Housing Information 0280 Other Document Containing Child's Name and Current Address
02 Housing Information 0334 Other Proof of Residency
02 Housing Information 0480 Proof of Additional Expenses
02 Housing Information 7309 Proof of contributions toward arrears
02 Housing Information 0272 Recent Letter from Doctor Clinic etc with Current Address
02 Housing Information 6709 Removal of Rent From DHS Shelter or Hotel Case
02 Housing Information 7170 Rental History Breakdown from Landlord
02 Housing Information 1600 Request for Approval of Special Grant 22 Moving Expenses
02 Housing Information 6732 Request for check - Cooperative Apartment Programs
02 Housing Information 1084 School Statement of Enrollment
02 Housing Information 6736 Security Deposit Agreement - Memo
02 Housing Information 6819 Statement from Another Person Re Current Residence-need 1 add'l doc
02 Housing Information 6901 Statement from Another Person Re Residence
02 Housing Information 1132 Statement from Financial Institution Lender
02 Housing Information 1120 Statement from Landlord regarding New Apt Security Deposit
02 Housing Information 1096 Statement from Licensed Broker
02 Housing Information 0296 Statement from Primary Tenant with Telephone Number
02 Housing Information 7378 Statement from Property Management Company
02 Housing Information 0332 Statement from Secondary Tenant
02 Housing Information 1104 Statement from Storage Facility
02 Housing Information 1108 Statement of Future Plan Moving outside NYC
02 Housing Information 1124 Statement Referral from Red Cross
02 Housing Information 5005 Tenant's Request for Inspection
02 Housing Information 7169 Third Party Proof of Income
02 Housing Information 1088 Three Estimates from Licensed Movers
02 Housing Information 1100 Three Itemized Estimates from Contractors
02 Housing Information 1128 Title to Property
02 Housing Information 6690 Transmittal HPD or SIP Coordinated Referrals
02 Housing Information 7439 Verification of program enrollment in a Residential Treatment Center
02 Housing Information 8206 W-116DD Advantage New York Employment Verification
02 Housing Information 8207 W-116EE Advantage New York Continuation Appointment
02 Housing Information 8211 W-116KK Advantage New York Documents Incomplete
02 Housing Information 8212 W-116MM Advantage New York Continuation Decision Notice
02 Housing Information 8243 W-116VV Advantage Program Continuation Decision Notice to the Landlord
02 Housing Information 1334 W-145 Notice of Intent to Restrict Shelter Allowance
02 Housing Information 1514 W-145A Notice to Landlord-Primary Tenant Rent Restrict Status
02 Housing Information 1338 W-145AA Notice to Client Determination of Rent Restriction
02 Housing Information 1342 W-145B Change in Two Party Direct Vendor Rent Payment
02 Housing Information 1358 W-145J Client's Request for Rent Restriction
02 Housing Information 1362 W-145JJ Client's Request for change in Rent Payment Method
02 Housing Information 0992 W-145N Request for Emergency Assistance
02 Housing Information 1370 W-145P Notice of Acceptance/Denial of Request for Housing Aid
02 Housing Information 6268 W-146 Landlord Request for Replacement of Direct Vendor Payment
02 Housing Information 6277 W-146D Agreement by Third Party to Pay Excess Rent
02 Housing Information 7173 W-146E completed and signed by third party
02 Housing Information 0316 W-146E Excess Rent & Third Party Proof of Income
02 Housing Information 6137 W-146F Request for Emergency Housing
02 Housing Information 5992 W-146R Client request for mailing address change
02 Housing Information 0312 W-146W Section 8 Verification
02 Housing Information 6269 W-146Y Direct Vendor Rent Program
02 Housing Information 6728 W-146Z Certification of Rent Payment
02 Housing Information 5144 W-147CC Certification of Move Statement
02 Housing Information 1378 W-147E NYCHA Security Agreement
02 Housing Information 8025 W-147F Shelter Arrears Repayment Agreement Worksheet
02 Housing Information 1382 W-147G Repayment Worksheet
02 Housing Information 1386 W-147H ESNA Shelter Arrears Repayment Agreement
02 Housing Information 7912 W-147JJ Broker's Statement for Fee Payment by Check
02 Housing Information 8026 W-147KK EAF Statement of Intent to Repay Excess Shelter Arrears
02 Housing Information 6661 W-147L Two-Party Check Discrepancy
02 Housing Information 7911 W-147M Landlord or Managing Agent's Statement
02 Housing Information 1518 W-147N Security Deposit Agreement
02 Housing Information 8143 W-147NN Information about Repaying the DSS for Utility Arrears
02 Housing Information 1390 W-147P Broker's Fee Voucher
02 Housing Information 8144 W-147PP Information about Repaying the DSS for Rental Arrears
02 Housing Information 0956 W-147Q Statement from Primary Tenant & Proof of Legal Tenancy
02 Housing Information 6270 W-147V Landlord Agreement
02 Housing Information 6133 W-147X Utility Arrears Repayment Agreement
02 Housing Information 5949 W-151A Action taken by Center to prevent eviction-hsing court
02 Housing Information 6975 W-166N Verification of ownership of premises
02 Housing Information 7531 W-25 DHS INS Worksheet
02 Housing Information 5981 W-30C Change of Address
02 Housing Information 6432 W-30FF Dwelling Survey Worksheet
02 Housing Information 8304 W-450Q Landlord Ombudsman Services Unit/Corrective Measures Needed
02 Housing Information 8303 W-450R Notice of Corrective Measures Taken
02 Housing Information 7088 W-501B EIHP Participant Statement of Commitment
02 Housing Information 7087 W-501G Notice of Acceptance for EIHP
02 Housing Information 7086 W-501P Employment Incentive Housing Program EIHP Lease Rider
02 Housing Information 1438 W-637B Request for an Advance to Prevent Eviction
02 Housing Information 0264 W-700C Verification of Pupil Registration
02 Housing Information 8161 W-761K Eviction Disposition
02 Housing Information 7698 W-897H DB Application For Non- Emergency Supportive Housing Form
02 Housing Information 7145 W-897M Rental Assistance Form I Request to Move to New Residenc
02 Housing Information 7217 W-897P Notification of Rent Payment Responsibility (RPR)
02 Housing Information 8314 W-897P-epu Notification Rent Payment Responsibility RPR CSRO-Family
02 Housing Information 9056 W-897T Notification of Rent Payment Responsibility (RPR Subsidy/30%)
02 Housing Information 8326 W-902U HRA-NYCHA Housing Referral
02 Housing Information 8390 W-902W CBCFA REQUEST FOR RECONSIDERATION
02 Housing Information 6429 W146B Notice Landlord Request for Restricting Rent Payment
02 Housing Information 8019 Work Advantage Document Packet
03 Utility Information 6677 "Utility Worksheet
03 Utility Information 0376 DSS-3596 Deferred Payment Agreement
03 Utility Information 0352 Electric Bill
03 Utility Information 8968 FIA-1104 Notice Regarding Your Request for a Utility Grant
03 Utility Information 0392 Fuel Bill Fuel Shut-off Notice
03 Utility Information 0904 Gas & Electric Bill
03 Utility Information 0356 Gas Bill
03 Utility Information 8528 H26HAS-Heap Program Notice of Approval Heater Household
03 Utility Information 7411 H36TDP Home Energy Assistance Program Documentation Requirement
03 Utility Information 7412 H37AP HEAP Program Notice Of Approval
03 Utility Information 7413 H38DN HEAP Program Notice Of Denial
03 Utility Information 7312 Heap 18 Notice Of Home Energy Assistance Program HEAP Benefit
03 Utility Information 6864 HEAP 22 all documents
03 Utility Information 6865 HEAP 23 all documents
03 Utility Information 7313 Heap 26 HEAP Notice of Approval Heater Households
03 Utility Information 7314 Heap 27 HEAP Notice of Approval Heat Included Renter's Benefit
03 Utility Information 7315 Heap 28 HEAP Program Notice of Denial
03 Utility Information 0372 HEAP Information
03 Utility Information 7311 HEAP Program Notice for Heater Households 2009-2010
03 Utility Information 7562 HEAP-11A Request for Energy Fuel Supplier Information for HEAP Grant
03 Utility Information 6727 HEAP-14 Notice of Direct Vendor HEAP Payment
03 Utility Information 6726 HEAP-15 Notice of HEAP Credit to Your Account
03 Utility Information 6576 HEAP-20 all documents
03 Utility Information 6863 HEAP-21 all documents
03 Utility Information 8040 HEAP-40 Cooling Assistance Notice of Eligibility Decision
03 Utility Information 8043 HEAP-41 Clean and Tune Program Notice of Eligibility Decision
03 Utility Information 8174 HEAP-42 Approval Notice
03 Utility Information 8175 HEAP-43 Denial Notice
03 Utility Information 8176 HEAP-44 Applicant Close Case Notice
03 Utility Information 8268 HEAP-6 Heap Program Notice for Heater Household
03 Utility Information 6725 HEAP-8 Notice of HEAP Credit to Your Account with Utility Company
03 Utility Information 0388 Lease Agreement for Water Sewage Garbage
03 Utility Information 7679 M-858 Notice to Utility Company of Direct Vendor Payment
03 Utility Information 1270 M-858c Notice of Intent to Restrict Energy Allowance Timely
03 Utility Information 1498 M-858d Utility Guarantee
03 Utility Information 1506 M-858v Notification to Utility Company
03 Utility Information 1274 M-858w Participant's Request for Utility Restriction
03 Utility Information 1278 M-858x Notice of Intent to Recoup Utility Grant Timely
03 Utility Information 1282 M-858y Request for Utility Grant
03 Utility Information 6678 Notification to Utility Company of Payment or Non-Payment
03 Utility Information 0344 Oil Bill
03 Utility Information 0340 Other Fuel Bill
03 Utility Information 0396 Proof of Air Conditioning Expense
03 Utility Information 0364 Telephone Bill
03 Utility Information 7376 Utilities restore notice
03 Utility Information 5524 Utility Bill
03 Utility Information 8241 Utility Company Statement
03 Utility Information 0952 Utility Company Temporary Shut-off Notice
03 Utility Information 6679 Utility Guarantee code 7 SIC Fair Hearing Update
03 Utility Information 0368 Utility Shut-off Notice
03 Utility Information 8027 W-147XX Utility Arrears Repayment Agreement Worksheet
03 Utility Information 6676 W209S IMProject Management Utility Bill Payment Case History
03 Utility Information 0336 Water Bill
03 Utility Information 0380 Water Sewage Bill
04 Miscellaneous 8011 Affidavits of Mailing
04 Miscellaneous 7153 AFIS Match Printout No other ID available all other sources exhausted
04 Miscellaneous 8506 BFI Child Care Documents
04 Miscellaneous 8508 BFI Civil Litigation Package
04 Miscellaneous 8491 BFI Historical Records (Prior to 2012)
04 Miscellaneous 8503 BFI Income/Resources Documents
04 Miscellaneous 8507 BFI Office of Child Support Enforcement Documents
04 Miscellaneous 8505 BFI Prescription Drug Fraud Documents
04 Miscellaneous 8504 BFI Residency Documents
04 Miscellaneous 8517 BFI-MIIPs Documents
04 Miscellaneous 7973 Burial Claims Unit Packet
04 Miscellaneous 7533 CASA archives or back files
04 Miscellaneous 8981 CILOCA Operation
04 Miscellaneous 8982 CILOCA Recertification
04 Miscellaneous 8998 Claims Detail Report – CDR
04 Miscellaneous 3012 Client Medication Record
04 Miscellaneous 7377 Document detailing disaster situation
04 Miscellaneous 8045 Documentation of in-kind hours
04 Miscellaneous 8159 DSS-3559 Long Term Care Facility Report
04 Miscellaneous 6580 DSS-4015
04 Miscellaneous 8594 Easy Image History
04 Miscellaneous 7184 EIP-ADDEV-1-196 V17 NYC Early Intervention Program Req for Add Eval
04 Miscellaneous 8999 eMedNY PrintOut
04 Miscellaneous 3008 Evaluation Reports
04 Miscellaneous 7005 EXP-76R Documentation Receipt
04 Miscellaneous 9000 Explanation of benefits
04 Miscellaneous 7466 Fair Hearing Packet Default judgments
04 Miscellaneous 8295 FAX HASA
04 Miscellaneous 7194 FF-17 Administrative Fraud Hearing Data
04 Miscellaneous 8888 FHEMS Packet
04 Miscellaneous 8863 FIA-1102 Scanning and Indexing Internal Paper Authorization Documents
04 Miscellaneous 9089 FIA-1130a Nurse Family Partnership Informational Appointment Notice
04 Miscellaneous 3011 Financial Management Documents
04 Miscellaneous 8311 FLY-86 Help is in Your Neighborhood
04 Miscellaneous 8861 H-10000 Helper Form
04 Miscellaneous 8120 Heavy Duty Cleaning Form
04 Miscellaneous 3005 HIV-Medical Clearance
04 Miscellaneous 8091 Homecare Miscellaneous Document
04 Miscellaneous 3001 Housing Application
04 Miscellaneous 3000 Housing Determination Letter
04 Miscellaneous 9001 Insurance Premium Invoice
04 Miscellaneous 3007 Intake Forms
04 Miscellaneous 8509 IREA C&C MA Income
04 Miscellaneous 7151 LDSS-4733 DFR Legal Residence Statement
04 Miscellaneous 7570 LDSS-4895 Date Entered Country DEC Data Entry Form Item 347
04 Miscellaneous 3010 Legal Documents
04 Miscellaneous 8514 LMD Review W410 & Supporting Docs
04 Miscellaneous 9033 Lombardi – UAS Assessment Outcomes Report
04 Miscellaneous 9032 Lombardi – UAS Level of care report (NF-LOC)
04 Miscellaneous 8983 Lombardi-UAS Assessment Report
04 Miscellaneous 7406 M-20d HCSP Homemaker Task Plan
04 Miscellaneous 6933 M-617h Home Visit Checklist of Services
04 Miscellaneous 6934 M-617j Checklist of Available Services
04 Miscellaneous 8157 MAP-58u List of Medicaid Offices and Facilitated Enrollers
04 Miscellaneous 1068 Medical Bills-3 Months Prior to Application
04 Miscellaneous 3009 Mental Hygiene Documents
04 Miscellaneous 3002 Mental Status Examination
04 Miscellaneous 3006 Miscellaneous
04 Miscellaneous 7197 NADAP-SACAP Recipient Daily Log
04 Miscellaneous 8924 Office of Quality Assurance & Fiscal Integrity Packet
04 Miscellaneous 8988 OQA Corrective Action Memos
04 Miscellaneous 8996 OQA Drops and ENE
04 Miscellaneous 8997 OQA External Capers
04 Miscellaneous 8995 OQA Payment Errors
04 Miscellaneous 8994 OQA Response
04 Miscellaneous 8989 OQA Supporting Documentation
04 Miscellaneous 8990 OQA Worksheet
04 Miscellaneous 0482 Other Proof Unable to Prepare Meals at Home
04 Miscellaneous 9002 Other supporting documents
04 Miscellaneous 3003 Psychosocial Document
04 Miscellaneous 8360 SASC Assessment Confidential Packet
04 Miscellaneous 3004 SCIMS
04 Miscellaneous 8956 Self Service Scan Receipt
04 Miscellaneous 8180 TCC-CCSS Child Care MISC
04 Miscellaneous 0404 Travel Documents
04 Miscellaneous 8954 Uniform Assessment System (UAS) Packet
04 Miscellaneous 5008 Unknown Form
04 Miscellaneous 8957 Unusable Self Service Scanned Document
04 Miscellaneous 8147 Vendor misc document (FOR VENDOR USE ONLY)
04 Miscellaneous 7405 W-186B Rivera Request Intake Form
04 Miscellaneous 7925 W-280M RMS 21-Day Call-in Letter
04 Miscellaneous 7142 W-502B SASC Assessment Interview
04 Miscellaneous 7141 W-502D Preparation Guide for the SASC Assessment Interview
04 Miscellaneous 7085 W-561BB Parental Acknowledgment
04 Miscellaneous 7120 W-585M BEV message center telephone questionnaire
04 Miscellaneous 7331 W-897 CBO Referral Satisfaction Form
04 Miscellaneous 9004 WMS MA history
04 Miscellaneous 5009 WMS Printout MA Pending MA-SSI Budget-WBGTMA and WBGTMB
04 Miscellaneous 9003 WMS restriction/exception inquiry
05 Absent Parent/LRR 6720 "OCSE Support Bonus Payment Worksheet
05 Absent Parent/LRR 6719 "W-209W Request for Issuance of Child Support Payments
05 Absent Parent/LRR 0488 Absent Parent Employment Information
05 Absent Parent/LRR 0492 Absent Parent Military Prison Institution Information
05 Absent Parent/LRR 0496 Absent Parent Remarriage Information
05 Absent Parent/LRR 0484 Absent Parent Spouse Housing Information
05 Absent Parent/LRR 7174 ACD 1173 Child Care Provider Contact/Emergency Medical Release Form
05 Absent Parent/LRR 8661 Affidavit of Due Diligence
05 Absent Parent/LRR 8662 Affidavit of Service by Mail
05 Absent Parent/LRR 7092 APLR750R 1 Office of child support enforcement referral
05 Absent Parent/LRR 6722 Child Support Payments Sufficient to met PA Budgetary Needs-Closings
05 Absent Parent/LRR 7067 CM-179 Affidavit Of Alleged Paternity
05 Absent Parent/LRR 7074 CM-179c Document or Information Checklist
05 Absent Parent/LRR 7068 CM-181b Custodial Parent OCSE Interview Sheet
05 Absent Parent/LRR 7069 CM-181c Guardian or Payee OCSE Interview Sheet
05 Absent Parent/LRR 5237 CM-182a IS OCSE Information Exchange OCSE Court Unit Report
05 Absent Parent/LRR 8970 CM-182b Child Support Cooperation Standards Checklist
05 Absent Parent/LRR 7072 CM-183e Employer Telephone Clearance Form
05 Absent Parent/LRR 7076 CM-511p CSMS Account Change Request
05 Absent Parent/LRR 0224 Court Adjudication or Order of Filation
05 Absent Parent/LRR 0532 Court Alimony Support Papers
05 Absent Parent/LRR 5010 Court Order of Custody
05 Absent Parent/LRR 1478 DSS-4281 Attestation to Lack of Information
05 Absent Parent/LRR 1590 DSS-4281 Attestation to Lack of Information-Spanish
05 Absent Parent/LRR 0208 DSS-4418 Acknowledgement of Paternity
05 Absent Parent/LRR 8218 EXP-85XX Request for proof of Bonus Payment Eligibility
05 Absent Parent/LRR 1040 Form M-384 OCSE Referral
05 Absent Parent/LRR 7421 Foster Care Checks or Copy of Checks
05 Absent Parent/LRR 6271 HHC-HS 590 Hospital Statement
05 Absent Parent/LRR 0536 Hospital Medical Records
05 Absent Parent/LRR 1624 LDSS-4279 Notice Responsibilities-Rights For Support
05 Absent Parent/LRR 9101 M-182a OCSE Information Transmittal
05 Absent Parent/LRR 8660 M-192z Case Control Sheet
05 Absent Parent/LRR 0504 M-251 Certified Letter
05 Absent Parent/LRR 7071 M-295 Fee Payment: Documentary Verification of Vital Statistics
05 Absent Parent/LRR 1494 M-384a Statement of Alleged Paternity
05 Absent Parent/LRR 0212 M-384b Acknowledgement of Paternity Signed
05 Absent Parent/LRR 0216 M-384bb Acknowledgement of Paternity
05 Absent Parent/LRR 1028 M-384d Recertification Absent Parent Questionnaire
05 Absent Parent/LRR 1024 M-384k M-384m Absent Parent Questionnaire
05 Absent Parent/LRR 6440 M-384N Letter of Introduction to Bureau of Child Support
05 Absent Parent/LRR 6156 M-384Q Statement of Alleged Paternity after birth of child
05 Absent Parent/LRR 7776 M-528m Child Care Guarantee Letter
05 Absent Parent/LRR 7188 M-528n Request for Child Care Assistance or to Close My PA Case
05 Absent Parent/LRR 6341 M-804 Summary to Family Court Support Proceedings
05 Absent Parent/LRR 6272 M-921 Notice of Legal Adoption
05 Absent Parent/LRR 6273 M-921G Authorization and Approval for Subsidized Adoption
05 Absent Parent/LRR 5954 M-984d Affidavit alleging paternity
05 Absent Parent/LRR 6904 Newspaper Notice Death of Parents
05 Absent Parent/LRR 8408 Non Compliance Letter FTR Court Unit – FTRCVEN
05 Absent Parent/LRR 8407 Non Compliance Letter FTR-C Program – FTRCRT
05 Absent Parent/LRR 7070 OCSE Establishing Paternity Letter
05 Absent Parent/LRR 7075 OCSE Letter of Authorization
05 Absent Parent/LRR 6721 OCSE Referral Work sheet
05 Absent Parent/LRR 8515 OCSE-179 OCSE Child Support Program Services Informational Flyer
05 Absent Parent/LRR 8516 OCSE-181 OCSE Customer Services Walk-in Center Referral
05 Absent Parent/LRR 8598 OCSE-224 OCSE Appointment Reminder
05 Absent Parent/LRR 8945 OCSE-272a Return Appointment Letter
05 Absent Parent/LRR 8864 OCSE-281 Office of Child Support Enforcement
05 Absent Parent/LRR 8865 OCSE-281a Office of Child Support Enforcement
05 Absent Parent/LRR 0524 Other Acceptable Evidence of Good Cause
05 Absent Parent/LRR 0220 Other Proof of Acknowledgement
05 Absent Parent/LRR 0544 Other Proof of Death- Absent Parent or Spouse
05 Absent Parent/LRR 0508 Other Verification of Absence
05 Absent Parent/LRR 0520 Police Reports Order of Protection
05 Absent Parent/LRR 0528 Proof Filed for Alimony Support
05 Absent Parent/LRR 5744 Registration of Absent or Putative Parents
05 Absent Parent/LRR 7420 Statement from Foster Care Agency
05 Absent Parent/LRR 0540 VA-Military Records
05 Absent Parent/LRR 0500 W-147 Letter to Landlord-Request for Residence Verification
05 Absent Parent/LRR 8858 W-273NN Child Care Return Appointment
05 Absent Parent/LRR 7078 W-273T Child Care Parental Attendance Report
05 Absent Parent/LRR 7922 W-280J Annual Review Letter PA Case
05 Absent Parent/LRR 7923 W-280K Annual Review Letter NPA Case
05 Absent Parent/LRR 7924 W-280L Locate Letter
05 Absent Parent/LRR 8217 W-351A Request for proof of Bonus Payment Eligibility(CAS)
05 Absent Parent/LRR 6442 W209X Important Notice Recipients About Child Support Bonus Pay
06 Income/Financial Statements 1064 40 Qtrs SSA Clearance-paper For documentation of work history only
06 Income/Financial Statements 8148 ACCIS Income Recoupment Packet
06 Income/Financial Statements 0744 Adoption Subsidy Benefit Statement
06 Income/Financial Statements 0748 Adoption Subsidy Check or Copy
06 Income/Financial Statements 0708 Alimony or Support Benefit Statement
06 Income/Financial Statements 0704 Alimony or Support Check or Copy
06 Income/Financial Statements 0668 Allotment Check or Copy
06 Income/Financial Statements 0804 Annuity Statement
06 Income/Financial Statements 7435 Appraisal of current value by dealer
06 Income/Financial Statements 7434 Appraisal or estimate of current value by broker
06 Income/Financial Statements 8534 ARU-SSI Case Packet
06 Income/Financial Statements 0416 Automobile Bill of Sale
06 Income/Financial Statements 0408 Automobile Estimates-Licensed Dealers 3
06 Income/Financial Statements 0432 Automobile Insurance Co. Report Letter
06 Income/Financial Statements 0412 Automobile Loan Book
06 Income/Financial Statements 0436 Automobile Loan Statement
06 Income/Financial Statements 0420 Automobile Registration
06 Income/Financial Statements 0424 Automobile Title
06 Income/Financial Statements 0604 Bank Account Statement
06 Income/Financial Statements 5751 Bank inquiry and clearance Report Agency Completed
06 Income/Financial Statements 0596 Bankbook or Passbook
06 Income/Financial Statements 8456 BFI-133 Waiver For Financial Inquiry
06 Income/Financial Statements 8448 BFI-150 Settlement Agreement
06 Income/Financial Statements 8441 BFI-154 Request for City Employment Payroll PMS
06 Income/Financial Statements 0760 Brokerage House or Financial Inst statement
06 Income/Financial Statements 5523 Budget Entry Supervisory Summary
06 Income/Financial Statements 0776 Burial Fund Record
06 Income/Financial Statements 0780 Burial Fund Trustee Statement
06 Income/Financial Statements 0784 Burial Plot Deed
06 Income/Financial Statements 0772 Burial Trust Agreement
06 Income/Financial Statements 7463 Cancelled checks or receipts re Other expenses or dependent care cost
06 Income/Financial Statements 5012 Change Report Form 2 sheets 4 pages
06 Income/Financial Statements 0700 Child Support Benefit Statement
06 Income/Financial Statements 0696 Child Support Check or Copy or Money Order or Copy
06 Income/Financial Statements 0460 Childcare Provider Letter Receipts
06 Income/Financial Statements 7453 Contact with source of unearned income
06 Income/Financial Statements 7454 Copy of the court order re: support or childcare or daycare
06 Income/Financial Statements 0816 Court Records Trust Fund Settlement Inheritance
06 Income/Financial Statements 7525 CS-274W Child Care Provider Enrollment Supplement
06 Income/Financial Statements 7301 Current Award Certificate or letter other income
06 Income/Financial Statements 7298 Current Award Certificate UIB
06 Income/Financial Statements 7300 Current Award Certificate/letter VA Benefits
06 Income/Financial Statements 6911 Current Award Letter VA Benefits
06 Income/Financial Statements 7459 Current Benefit Check or Copy other income
06 Income/Financial Statements 7460 Current Contribution Check
06 Income/Financial Statements 7449 Current income tax return
06 Income/Financial Statements 0684 Current Receipts for Boarder or Lodger
06 Income/Financial Statements 7303 Current wage stubs and Statement of Tips
06 Income/Financial Statements 8345 Dept of Treasury Financial Statement
06 Income/Financial Statements 0712 Disability Insurance Benefit Statement or Award Notice
06 Income/Financial Statements 0636 Dividends Interest Check or Copy
06 Income/Financial Statements 0632 Dividends or Interest Statement
06 Income/Financial Statements 7464 Documentation of garnishments taken from pay eg pay stub or statement
06 Income/Financial Statements 6528 DOH-676 Income and Residency Verification
06 Income/Financial Statements 7883 DSP SSI
06 Income/Financial Statements 5421 DSS-2521 Application for Child Support Services
06 Income/Financial Statements 5015 DSS-3575 PA Single Issuance Authorization Form Payment
06 Income/Financial Statements 6253 DSS-3715 EL SSI Benefits Levels
06 Income/Financial Statements 6255 DSS-3715EL Supplemental Security Income Benefit Levels
06 Income/Financial Statements 5965 DSS-4300 Assignment of Wages Salary other compensation for Services
06 Income/Financial Statements 6274 DSS-517 Budget Worksheet-Medical Assistance
06 Income/Financial Statements 7433 EITC check or copy
06 Income/Financial Statements 7448 Employer letter indicating the number of hours worked and rate of pay
06 Income/Financial Statements 8476 FIA-1042-Notice of Employment
06 Income/Financial Statements 8179 Financial Management Unit Addendum
06 Income/Financial Statements 8712 FMU Client Statements
06 Income/Financial Statements 6917 Household Statement of current value
06 Income/Financial Statements 0732 HUD Allowance Benefit Statement
06 Income/Financial Statements 0736 HUD Allowance Check or Copy
06 Income/Financial Statements 0828 In-Trust Account Statement
06 Income/Financial Statements 7305 Income tax records
06 Income/Financial Statements 6919 Insurance Appraisal
06 Income/Financial Statements 0756 Insurance Company Statement
06 Income/Financial Statements 7668 IREA L&R Real Property Liens
06 Income/Financial Statements 0556 Job Letter
06 Income/Financial Statements 6392 Job Notice FIA-3A
06 Income/Financial Statements 9024 Law Dept Paid in Full
06 Income/Financial Statements 1736 LDSS-4530 Assignment of Wages Salary Other Compensation for Services
06 Income/Financial Statements 0464 Letter from Institution tuition
06 Income/Financial Statements 0612 Life Insurance Policy
06 Income/Financial Statements 0728 Loan Statement
06 Income/Financial Statements 1238 M-15f Agreement to Repay PA
06 Income/Financial Statements 1020 M-30t Verification of Unreported Employment
06 Income/Financial Statements 6755 M-321j MIS Request for Information About Earned Income
06 Income/Financial Statements 7511 M-696f HRA Plan of Self - Support Worksheet
06 Income/Financial Statements 6276 MAP 2071A Assignment of Support from Community Spouse
06 Income/Financial Statements 5796 MAP-2135A Requirement for a Separate Burial Fund Account
06 Income/Financial Statements 7132 Medical bills
06 Income/Financial Statements 7455 Medicare deductions
06 Income/Financial Statements 0664 Military Allotment Benefit Statement
06 Income/Financial Statements 0716 No Fault Insurance Benefit Statement
06 Income/Financial Statements 0652 NYS Disability Check or Copy seen
06 Income/Financial Statements 0648 NYS Disability Statement
06 Income/Financial Statements 7523 OCFS-LDSS-469 Enrollment Form Provider of Legally-Exempt Child Care
06 Income/Financial Statements 7524 OCFS-LDSS-4700 Enrollment Provider Legally-Exempt Group Child Care
06 Income/Financial Statements 5251 OES-3A Job Notice OES
06 Income/Financial Statements 7302 Official correspondence from source of income Other income
06 Income/Financial Statements 7408 Official correspondence regarding liens levies and fines
06 Income/Financial Statements 0740 Other Document Verifying Past Management
06 Income/Financial Statements 0758 Other Income Statement
06 Income/Financial Statements 1140 Other Liquid Resource Statement
06 Income/Financial Statements 0824 Other Resource Statement
06 Income/Financial Statements 6920 Pay Envelope
06 Income/Financial Statements 0548 Pay Stubs
06 Income/Financial Statements 0552 Pay Stubs Last 4 Weeks of Pay
06 Income/Financial Statements 0428 Police Accident Report & Insurance Letter automobile
06 Income/Financial Statements 0452 Police Stolen Car Report & Ins. Co. Letter Report
06 Income/Financial Statements 8354 POS Budget Letter for Cash Assistance Case
06 Income/Financial Statements 1072 Proof of Income & Resources-3 Months Prior to Application
06 Income/Financial Statements 0478 Proof of Medical Expenses
06 Income/Financial Statements 0586 Proof of non-applying Step Parent Income and Resources
06 Income/Financial Statements 0444 Proof of Non-Ownership automobile
06 Income/Financial Statements 8671 Proof of Paid Medical Bills
06 Income/Financial Statements 0468 Proof of Payment Legally Obligated Child Support
06 Income/Financial Statements 0448 Proof of Repossession automobile
06 Income/Financial Statements 7307 Proof of SSA or SSI benefits for disability or blindness
06 Income/Financial Statements 0796 Property non-home Deed
06 Income/Financial Statements 0792 Property Real Estate Statement
06 Income/Financial Statements 7187 Property Tax Statement
06 Income/Financial Statements 0564 Quarterly Estimated Tax
06 Income/Financial Statements 7634 RAF II - Ongoing & Increase Rent
06 Income/Financial Statements 0592 Railroad Benefit Check or Copy
06 Income/Financial Statements 0588 Railroad Benefit Letter
06 Income/Financial Statements 0692 Receipts from Contributor or Donor
06 Income/Financial Statements 0568 Records & Related Mat'l Concerning Earnings & Expenses
06 Income/Financial Statements 7304 Records related materials concerning self-employment earnings expenses
06 Income/Financial Statements 6240 Report of Student Beneficiary at End of School Year
06 Income/Financial Statements 5922 Report of Support Collected
06 Income/Financial Statements 0624 Retirement Benefit Letter
06 Income/Financial Statements 0628 Retirement Check or Copy
06 Income/Financial Statements 5935 Retirement Survivors and Disability Insurance Important Information
06 Income/Financial Statements 0594 Room and Board Receipts
06 Income/Financial Statements 0590 Sales or Purchasing Agreement
06 Income/Financial Statements 6918 Sales Slips
06 Income/Financial Statements 0768 Savings Bonds
06 Income/Financial Statements 5819 Social Security Administration Supplemental Security Income Notice Pl
06 Income/Financial Statements 0600 Social Security Award Letter
06 Income/Financial Statements 0584 Social Security Check or Copy
06 Income/Financial Statements 0936 SSA 7004-Benefit Estimate Stmt For docum of work history only
06 Income/Financial Statements 1178 SSA Benefit Termination Statement
06 Income/Financial Statements 0844 SSA Survivor's Benefits Letter for Minor
06 Income/Financial Statements 6186 SSA-1 Application for Widow's or Widower's Insurance Benefits
06 Income/Financial Statements 6150 SSA-2708 Social Security Administration Important Information
06 Income/Financial Statements 7914 SSA-3288 Consent for Release of Information
06 Income/Financial Statements 6275 SSA-45 Receipt for Your Claim for S-S Retirement Insurance Benefits
06 Income/Financial Statements 6505 SSA-633-U3 Agreement to Refund Overpayment
06 Income/Financial Statements 5016 SSA-8000-BK Receipt for Claim of Supplemental Security Income
06 Income/Financial Statements 5898 SSA-8001-ES Receipt for Claim for Supplemental Security Income
06 Income/Financial Statements 6151 SSA-8166 Social Security Administration Supplemental Security Income
06 Income/Financial Statements 5866 SSA-L1043 Important Information
06 Income/Financial Statements 5905 SSA-L634 Social Security Benefit Information
06 Income/Financial Statements 5847 SSA-L815 Changes in your Supplemental Security Income Payment Letter
06 Income/Financial Statements 5011 SSA-L8151 Change of Payment-SSI Notice of
06 Income/Financial Statements 6162 SSA-L8166 Supplemental Security Income Important Information
06 Income/Financial Statements 6256 SSA-L8457 SSI Notice of Reconsideration
06 Income/Financial Statements 5916 SSA-L991-U3 Why you are not eligible for SSI
06 Income/Financial Statements 5907 SSA-SSI Input Information not Eligible for SSI SSA-1991-U3
06 Income/Financial Statements 0616 SSI Award Letter
06 Income/Financial Statements 0580 SSI Check or Copy
06 Income/Financial Statements 8614 SSI/SSDI Supplemented Application
06 Income/Financial Statements 1142 Statement detailing circumstances surrounding Loss Theft
06 Income/Financial Statements 7451 Statement from Agency Administering Educational Grant or Award
06 Income/Financial Statements 7462 Statement from Aide or Attendant re Daycare or Childcare
06 Income/Financial Statements 7450 Statement from applicant participant attesting to unverifiable income
06 Income/Financial Statements 0812 Statement from Attorney
06 Income/Financial Statements 0680 Statement from Boarder or Lodger
06 Income/Financial Statements 7299 Statement from Broker or Agent re Interest or Dividends or Royalties
06 Income/Financial Statements 0908 Statement from Cemetery or Mortuary
06 Income/Financial Statements 0688 Statement from Contributor or Donor
06 Income/Financial Statements 7461 Statement from Daycare Center or Other Child Care Provider
06 Income/Financial Statements 0928 Statement from Employer
06 Income/Financial Statements 0820 Statement from expected Other Income Source
06 Income/Financial Statements 7296 Statement from Family Court Child Support
06 Income/Financial Statements 0788 Statement from Funeral Director/Funeral Bill
06 Income/Financial Statements 0840 Statement from Government Agency paying bill
06 Income/Financial Statements 0896 Statement from Joint Owner
06 Income/Financial Statements 7429 Statement from Nursing Home
06 Income/Financial Statements 7297 Statement from Person Paying Child Support
06 Income/Financial Statements 0912 Statement from Person/Group or Organization
06 Income/Financial Statements 7436 Statement from source of payment
06 Income/Financial Statements 7457 Statement from Source of Payment lump sum
06 Income/Financial Statements 7432 Statement from Tax Office
06 Income/Financial Statements 0676 Statement of Received Rental Income
06 Income/Financial Statements 0608 Statement of Support
06 Income/Financial Statements 0832 Statement Sale or Transfer or Created Trust
06 Income/Financial Statements 0764 Stock Certificates
06 Income/Financial Statements 5017 Summer Child Care Payment Transmittal Form
06 Income/Financial Statements 5018 Supplemental payment
06 Income/Financial Statements 7428 Support Check Stubs
06 Income/Financial Statements 0400 Tax Bill showing ownership of house
06 Income/Financial Statements 0560 Tax Return
06 Income/Financial Statements 0800 Tax Return Check or Copy
06 Income/Financial Statements 8182 TCC-Client Detail Summary For Income Eligibility
06 Income/Financial Statements 7598 The Work Number Income Verification Print-Out
06 Income/Financial Statements 7444 Transcript or financial aid breakdown
06 Income/Financial Statements 0808 Trust Agreement
06 Income/Financial Statements 0752 Trust Fund Income Statement
06 Income/Financial Statements 0620 UIB Booklet or Printout
06 Income/Financial Statements 0572 UIB Check or Copy
06 Income/Financial Statements 0576 UIB Statement
06 Income/Financial Statements 0724 Union Benefit Check or Copy
06 Income/Financial Statements 0720 Union Statement
06 Income/Financial Statements 0656 VA Benefit Statement
06 Income/Financial Statements 0660 VA Check or Copy
06 Income/Financial Statements 7479 VA Spinal Bifida Award Letter or Certificate
06 Income/Financial Statements 7481 VA Spinal Bifida Statement
06 Income/Financial Statements 1136 Verification Income Resources Stopped Exhausted
06 Income/Financial Statements 6573 W-112E Wage Reporting Clearance
06 Income/Financial Statements 1510 W-122D FS Budget Worksheet PA
06 Income/Financial Statements 1294 W-122DD FS Budget Worksheet PA-SSI-Aged Disabled
06 Income/Financial Statements 6350 W-128HH Notice to Recipients SSI Check Retro Benefit Calc
06 Income/Financial Statements 5859 W-138 Employment Earnings Questionnaire
06 Income/Financial Statements 1318 W-140B SSI Family PA Calculation NON-ISAS Unit
06 Income/Financial Statements 1322 W-140C Non-SSI Family PA Calculation NON-ISAS Unit
06 Income/Financial Statements 1326 W-140D SSI Single Person PA Calculation NON-ISAS Unit
06 Income/Financial Statements 1682 W-140DD New Claim Calculation Worksheet
06 Income/Financial Statements 1330 W-140E Enhance Rent Calculation Worksheet
06 Income/Financial Statements 1676 W-140K Expedited Service Worksheet
06 Income/Financial Statements 1680 W-140M Discrepant Eligibility Information Tracking Form
06 Income/Financial Statements 6278 W-163A Agreement to Repay Safety Net Assistance Still Owed
06 Income/Financial Statements 7216 W-2 Form
06 Income/Financial Statements 6238 W-2-496 Real Property & Asset Section Transmittal Sheet
06 Income/Financial Statements 5985 W-205A Checks Receipt
06 Income/Financial Statements 5013 W-232 SP Check Copy-Payment to Daycare Provider
06 Income/Financial Statements 0456 W-273B Childcare Provider Form
06 Income/Financial Statements 5160 W-273B S Childcare Provider Form Spanish
06 Income/Financial Statements 7379 W-274U Attestation of Employment: Informal Child Care Provider
06 Income/Financial Statements 7380 W-274UU Income Verification for Child Care Provider Letter
06 Income/Financial Statements 1000 W-451 NYPD-Job Center Report/Referral
06 Income/Financial Statements 7920 W-475A DARBIDUN
06 Income/Financial Statements 7921 W-493A DARBIDUN
06 Income/Financial Statements 7913 W-500QQ TALX The Work Number Express Services Data Sheet
06 Income/Financial Statements 7595 W-501K EIHP Monthly Household Income Contribution Worksheet
06 Income/Financial Statements 0996 W-532 Letter to Past/Present Employer
06 Income/Financial Statements 1004 W-532f Financial Institution Inquiry
06 Income/Financial Statements 5014 W-574DD Client Change Form
06 Income/Financial Statements 6816 W-575T Declaration of Employment
06 Income/Financial Statements 6657 W-587G Real Property and Assets Inquiries
06 Income/Financial Statements 7696 W-592R Employment Income Questionnaire Letters
06 Income/Financial Statements 6027 W-638A Financial Inquiry
06 Income/Financial Statements 1442 W-648 Family Budget Calculation
06 Income/Financial Statements 6662 W-648A Step-Parent Income Budget Worksheet
06 Income/Financial Statements 6815 W-648B Alien Sponsor or Step-Parent Budget Worksheet
06 Income/Financial Statements 8230 W-648J Congregate Care Budget Worksheet
06 Income/Financial Statements 8262 W-648K Income Saving Requirement Worksheet
06 Income/Financial Statements 8263 W-648M Temporary Housing Budget Worksheet
06 Income/Financial Statements 0672 W-700V Educational Grants or Loans
06 Income/Financial Statements 7919 W-820 DARBIDUN
06 Income/Financial Statements 7917 W-820A DARRECPT
06 Income/Financial Statements 7918 W-820B DARRECPT
06 Income/Financial Statements 9095 W-9 Request for Taxpayer Identification Number and Certification
06 Income/Financial Statements 9092 W2-174C Request for Emergency Assistance
06 Income/Financial Statements 7615 W34A Clothing Grants-CBCFA
06 Income/Financial Statements 7285 WINRO027 PA or FS Budget Summary
06 Income/Financial Statements 6624 Worker's Compensation WCB New Claim - Bi weekly payment status
06 Income/Financial Statements 6625 Worker's Compensation WCB New Claim - Bi weekly status
06 Income/Financial Statements 0640 Workers' Compensation Board Statement or Award letter
06 Income/Financial Statements 0644 Workers' Compensation Check or Copy
06 Income/Financial Statements 5996 WR2 Concealed Income Worksheet
07 Correspondence/Notices 6641 "W-145K Voluntary Rent or Utility Restriction Notice
07 Correspondence/Notices 6646 "W-146A Notice of Participants Receiving Restricted Rent Check
07 Correspondence/Notices 8966 ABAWD Mailing Correction
07 Correspondence/Notices 7243 ACD-1061 ACD - Notice of Rejection of Day Care Application
07 Correspondence/Notices 8984 Advance Notice of Proposed Action
07 Correspondence/Notices 5024 Advance Notice of Your Administrative Disqualification Hearing 3 pages
07 Correspondence/Notices 8184 APL320 Case Closure Warning- Location Services Child Support
07 Correspondence/Notices 8185 APL325 Case Closure Warning- Support Order Must be Filed
07 Correspondence/Notices 8186 APL330 Case Closure Warning- No Child Support Order Entered
07 Correspondence/Notices 8187 APL335 Case Closure Warning- Interstate Packet Needed
07 Correspondence/Notices 5027 Appointment Letter any kind
07 Correspondence/Notices 8003 APS FMU Client Statements
07 Correspondence/Notices 9012 APS Letter to Landlord upon termination of client
07 Correspondence/Notices 9009 APS Letter to Landlord: New Client Activation or change to existing budget
07 Correspondence/Notices 9011 APS Letter to Utility Vendor upon termination of client
07 Correspondence/Notices 8139 APS Referral Letter
07 Correspondence/Notices 9010 APS Rep Payee request approval notification to the Client
07 Correspondence/Notices 9007 APS Rep Payee request info to Client
07 Correspondence/Notices 9006 APS Rep Payee request to SSA
07 Correspondence/Notices 9013 APS Termination of Rep Payee services notification to Client
07 Correspondence/Notices 9008 APS To Utility Vendor: New Client Activation or change to existing budget
07 Correspondence/Notices 8437 BFI-155 Photo Array Form
07 Correspondence/Notices 8439 BFI-164 Prescription Receipt
07 Correspondence/Notices 7155 BFI-25 BFI Appointment Letter
07 Correspondence/Notices 8422 BFI-31 Address information request
07 Correspondence/Notices 7156 BFI-36 BFI Letter to Landlord re Household Presence or Composition
07 Correspondence/Notices 8438 BFI-39 Photo ID for Employment Verification
07 Correspondence/Notices 7094 BFI-44 Voluntary Statement
07 Correspondence/Notices 8467 BFI-Allegation
07 Correspondence/Notices 8466 BFI-DA Package
07 Correspondence/Notices 8463 BFI-Doctor Statements
07 Correspondence/Notices 8464 BFI-Food Stamp Claim Package
07 Correspondence/Notices 8465 BFI-IPV Package
07 Correspondence/Notices 8359 CAS-202 DSP Request for Additional Information
07 Correspondence/Notices 8844 CAS-203 Notification to SSA Change of Authorized Representative Status
07 Correspondence/Notices 8845 CAS-204 Disability Services Program Hearing Preparation Notification
07 Correspondence/Notices 8846 CAS-207 Disability Services Program Authorized Representative
07 Correspondence/Notices 8847 CAS-208 Disability Services Program Appeal Assessment Appointment
07 Correspondence/Notices 8848 CAS-209 Disability Services Program Assessment Interview
07 Correspondence/Notices 8876 CAS-502B Missed Mandatory Appointment for Evaluation of Work Activity
07 Correspondence/Notices 9036 CAS-512 Notice of Retroactive Payment
07 Correspondence/Notices 9052 CAS-515 Notice to Tenant With Employment Income
07 Correspondence/Notices 8064 Case Management Notes
07 Correspondence/Notices 8642 CC-114 IREA Div of Claims Letter to Sponsor
07 Correspondence/Notices 9028 CC-122k Sponsor Refund Letter
07 Correspondence/Notices 5755 Certification of Title IV E ADC-FC Categorical and Financial Eligib
07 Correspondence/Notices 6176 Certified Mail Receipt
07 Correspondence/Notices 9062 Child Care Termination Notice
07 Correspondence/Notices 9064 Child Enrollment Confirmation
07 Correspondence/Notices 7032 CM-174 First Contact Letter OCSE
07 Correspondence/Notices 7033 CM-174a Second Contact Letter OCSE
07 Correspondence/Notices 8121 Consent for the release of confidential alcohol or drug treatment
07 Correspondence/Notices 7676 Consumer or Client handwritten or typed letter any kind
07 Correspondence/Notices 8744 CSET-Assignor Notice
07 Correspondence/Notices 5029 Denial Notice of
07 Correspondence/Notices 7038 DFRP Closing Letter OCSE Child Support Greater Than PA Needs
07 Correspondence/Notices 7027 DHS-309 Att. to Applicants Emerg. Housing Serv w pend elig
07 Correspondence/Notices 5030 Documentation Return Letter
07 Correspondence/Notices 9067 Drop 13 Year Old Termination Letter (Client)
07 Correspondence/Notices 9066 Drop 13 Year Old Termination Letter (Provider)
07 Correspondence/Notices 7878 DSP Appointment Letter
07 Correspondence/Notices 6102 DSS-109 Notification of action taken - termination of benefits
07 Correspondence/Notices 7007 DSS-3156 Notice Of FS Overpayment Demand Letter replaces EXP-36H
07 Correspondence/Notices 6279 DSS-3340 Change Appellant Information Form
07 Correspondence/Notices 6928 DSS-3622 Notice of Decision on Your Medicaid Application
07 Correspondence/Notices 6280 DSS-3623 Notice of Intent to Discontinue or Change Medical Assistance
07 Correspondence/Notices 5895 DSS-3631 Personal Privacy Protection Law Notification to Clients
07 Correspondence/Notices 6183 DSS-3792 Aid to Continue Directive
07 Correspondence/Notices 6543 DSS-4022 Notice of Intent to Establish Liability Toward Chronic Care
07 Correspondence/Notices 6206 DSS-4218 Fair Hearing Request Form-Fax or Mail
07 Correspondence/Notices 5026 DSS-4220 Notice to Appellant Spanish version
07 Correspondence/Notices 6552 DSS-4231 Option to End Your Sanction
07 Correspondence/Notices 6260 DSS-L-3926-EP Your Benefits Will Continue in the Same Amount
07 Correspondence/Notices 6447 DSS4482/20 Transmittal Of Fair Hearing Decision to Representative
07 Correspondence/Notices 1620 EBT-23 Notice of Special PA or FS Benefits
07 Correspondence/Notices 7084 EBT-23 S Notice of Special PA/FS Benefits Spanish
07 Correspondence/Notices 8829 EBT-53 Pin Pad Password Request
07 Correspondence/Notices 8830 EBT-56 Administrative Terminal Password Request
07 Correspondence/Notices 8831 EBT-59 Common Benefit Identification Card
07 Correspondence/Notices 5031 Eligibility Denial or Ending Status Notice of
07 Correspondence/Notices 8049 EXP-76CC Homebound Review Project Mail Return
07 Correspondence/Notices 8050 EXP-76DD Homebound Review Project General Telephone Log
07 Correspondence/Notices 7009 EXP-76K S Recertification Update Notice Spanish
07 Correspondence/Notices 7686 EXP-78PP Intensive Services Center Letter
07 Correspondence/Notices 7371 EXP-78QQ Family Services Call Center Documentation Request
07 Correspondence/Notices 7555 EXP-83C Job Fair Notice
07 Correspondence/Notices 7856 EXP-83X MKB Retroactive Relief Worksheet
07 Correspondence/Notices 7688 EXP-84 Outreach Letter
07 Correspondence/Notices 7943 EXP-84DD Job Fair Notice
07 Correspondence/Notices 7952 EXP-84FF Homebound Review Project/Notice of Decision
07 Correspondence/Notices 7953 EXP-84GG You May Be Owed Money By the City of New York
07 Correspondence/Notices 7954 EXP-84HH Homebound Review Project/Decision/Your Request for a Review
07 Correspondence/Notices 7955 EXP-84JJ Homebound Review Project/Outreach Return Form
07 Correspondence/Notices 8051 EXP-84KK Remove Homebound Status Request Form
07 Correspondence/Notices 7855 EXP-84M Child Support Voluntary Appointment Notice
07 Correspondence/Notices 8053 EXP-84QQ Request for a Homebound Application Interview
07 Correspondence/Notices 8052 EXP-84RR Homebound Review Project Eligible for Retroactive Medicaid
07 Correspondence/Notices 7854 EXP-84T Notice of Overpayment
07 Correspondence/Notices 8054 EXP-84WW Notice of Outcome of Your Case Review
07 Correspondence/Notices 8055 EXP-84XX Acknowledgement of Telephone Request for a Case Review
07 Correspondence/Notices 7978 EXP-85C Appointment Notice
07 Correspondence/Notices 8125 EXP-85W Notice of Job Preparation Day
07 Correspondence/Notices 5032 Expiration of Food Stamp Benefits and Recertification Notice of
07 Correspondence/Notices 7979 FCP405L1 Intent To Close Letter
07 Correspondence/Notices 7980 FCP405L1D Intent To Close Deceased Respondent Letter
07 Correspondence/Notices 8823 FIA-1026b Appointment Notice Child Care in Lieu of Cash Assistance
07 Correspondence/Notices 8824 FIA-1026c Rescheduled Appointment for Child Care Cash Assistance
07 Correspondence/Notices 8310 FIA-1028 Home Visits Needed/Homebound Determination Process
07 Correspondence/Notices 8682 FIA-1077 Hercules Settlement Payment
07 Correspondence/Notices 8825 FIA-1093 Child Care Cash Assistance Recertification Appointment
07 Correspondence/Notices 8805 FIA-1094 Comprehensive Letter
07 Correspondence/Notices 8819 FIA-1094b Important Notice Regarding Your Recertification Appointment
07 Correspondence/Notices 8820 FIA-1094c Notice Regarding Your SNAP Application
07 Correspondence/Notices 8821 FIA-1094d Batch Cancellation Notice
07 Correspondence/Notices 8822 FIA-1094e Notice of Removal of Recoupment
07 Correspondence/Notices 8896 FIA-1094f Notice of a Refund of a Transferred Recoupment
07 Correspondence/Notices 8826 FIA-1094h Recoupment Transfer Notice
07 Correspondence/Notices 8827 FIA-1094i Recoupment Transfer and Refund Notice
07 Correspondence/Notices 8841 FIA-1094m Regarding the Hercules Notice You Recently Received
07 Correspondence/Notices 8842 FIA-1094n Hercules Notice You Recently Received March 20, 2013
07 Correspondence/Notices 8807 FIA-1095 Able Bodied Adults Without Dependents (WEP) Assignment Letter
07 Correspondence/Notices 9075 FIA-1125d Change in Your Cash Assistance Grant Recoupment Rate Change
07 Correspondence/Notices 9068 FIA-1127 Notice to Household of Storage Fee Payment to Vendor
07 Correspondence/Notices 9069 FIA-1127a Notice to Household of Storage Fee Payment Termination
07 Correspondence/Notices 9070 FIA-1127b Notice to Vendor of Storage Fee Payment
07 Correspondence/Notices 9071 FIA-1127c Notice to Vendor of Storage Fee Payment Termination
07 Correspondence/Notices 9096 FIA-1128 Special Lovely H. Settlement Payment for Closed CA Cases
07 Correspondence/Notices 9097 FIA-1128a Response Needed for Special Lovely H. Settlement Payment
07 Correspondence/Notices 9098 FIA-1128b Special Lovely H. Settlement Payment for Open CA Cases
07 Correspondence/Notices 9099 FIA-1128c Special Lovely H. Settlement SNAP Benefits Payment
07 Correspondence/Notices 9100 FIA-1128d Eligibility for Special Lovely H. Medical Benefits
07 Correspondence/Notices 8811 FIA1094a Supplemental Nutrition Assistance Recertification Appointment
07 Correspondence/Notices 9060 Financial Management Service Package
07 Correspondence/Notices 7944 HEAPHA29 SUA1 Notice of Home Energy Assistance Program Grant
07 Correspondence/Notices 5034 Information and or Documentation Request for
07 Correspondence/Notices 8934 Information/Documentation request from OLA
07 Correspondence/Notices 5037 Intentional Program Violation Disqualification Notice for PA and FS Benefits
07 Correspondence/Notices 7963 IREA C&C REFERRALS
07 Correspondence/Notices 8813 LDSS 4779 Approval of Your Application for Child Care Benefits
07 Correspondence/Notices 8814 LDSS 4780 Denial of Your Application for Child Care Benefits
07 Correspondence/Notices 7583 LDSS-4005 NYC Notice of Temp or Asst Work Require Determin or Exempt
07 Correspondence/Notices 7584 LDSS-4005a NYC Notice of Temp or Asst Work Require Deter-Non-Exempt
07 Correspondence/Notices 6962 LDSS-4013A NYC Action Taken On Your Application PA FS and MA
07 Correspondence/Notices 6963 LDSS-4013B NYC Action Taken On Your Application PA FS and MA
07 Correspondence/Notices 6964 LDSS-4014A NYC Action Taken On Your Recert PA FS MA
07 Correspondence/Notices 6965 LDSS-4014B NYC Action Taken On Your Recert PA FS MA
07 Correspondence/Notices 6966 LDSS-4015A NYC Notice of Intent To Change Benefits PA FS MA
07 Correspondence/Notices 6967 LDSS-4015B NYC Notice of Intent To Change Benefits PA FS MA
07 Correspondence/Notices 6968 LDSS-4016A NYC Notice of Intent To Change Benefits PA FS MA
07 Correspondence/Notices 6969 LDSS-4016B NYC Notice of Intent To Change Benefits PA FS MA
07 Correspondence/Notices 7961 LDSS-4776 Safety Net Assistance Application Supplement
07 Correspondence/Notices 1698 Letter From Supervising Adult in Household
07 Correspondence/Notices 6542 M-11J Notice of Decision to Provide Home Care Services
07 Correspondence/Notices 6796 M-186hh Notice of Mandatory Dispute Resolution Notice of Intent
07 Correspondence/Notices 1718 M-186JJ Notice of Mandatory Dispute Resolution NOI
07 Correspondence/Notices 6797 M-186rr Mandatory Dispute Resolution Action Taken Form
07 Correspondence/Notices 6078 M-255B Notice of Case Transfer
07 Correspondence/Notices 1222 M-3 Action Taken on Your Application:PA-MA-FS
07 Correspondence/Notices 1246 M-31g Notice to report to Social Security Office
07 Correspondence/Notices 6758 M-321 Recertification Appointment Job Center
07 Correspondence/Notices 6754 M-321k Food Stamp Recertification Notice
07 Correspondence/Notices 6283 M-322F LDSS-4594 Decision Notice: Waiver Temp Delay PA Require
07 Correspondence/Notices 1742 M-327f Time Limit Reassessment Interview
07 Correspondence/Notices 8012 M-327h Mail-In Recertification/Eligibility Questionnaire
07 Correspondence/Notices 6092 M-328A Notice of Intent to Reduce Public Assistance
07 Correspondence/Notices 8204 M-328AA Notices for Recoupment Transfers
07 Correspondence/Notices 6079 M-328B Notice of Change in Grant
07 Correspondence/Notices 6080 M-328H Notice of Change in Grant
07 Correspondence/Notices 6093 M-328N Notice of Intent to Reduce Public Assistance
07 Correspondence/Notices 6096 M-33A Notice Regarding Lump Sum Payment
07 Correspondence/Notices 6284 M-3a Notice of Reduction of Public Assistance and/or FS Benefits due
07 Correspondence/Notices 6285 M-3b Understanding of Documentation Requirements
07 Correspondence/Notices 1226 M-3c-a Notice of Intent to Change Continue Benefits
07 Correspondence/Notices 5036 M-3c-b Intent to Discontinue PA-FS-MA Benefits Notice of
07 Correspondence/Notices 1250 M-3e Clients Acknowledgement of change in benefits
07 Correspondence/Notices 6544 M-3f Notice of Non-Acceptance
07 Correspondence/Notices 1254 M-3g Notice to Report to Center
07 Correspondence/Notices 1644 M-3mm Notification of Application Withdrawal
07 Correspondence/Notices 6184 M-40k Notice of Denial of Expedited FS or Inability to Issue FS
07 Correspondence/Notices 5081 M-42e Notice Concerning Your Medicaid Application
07 Correspondence/Notices 6081 M-55 Notice of Change of Center
07 Correspondence/Notices 1752 M-687k Safety Net Assistance Application Interview
07 Correspondence/Notices 8333 M-74 Application to The Residential Treatment Service Center (RTSC)
07 Correspondence/Notices 6788 M-74e NYCWAY Mandatory Appointment Letter
07 Correspondence/Notices 6789 M-74f NYCWAY Appointment Letter-Voluntary
07 Correspondence/Notices 6045 M-75b Important Notice Request for medical examination
07 Correspondence/Notices 7232 M-75bb Substance Abuse Initial Appointment
07 Correspondence/Notices 1710 M-75g Consent for Disclosure of MAP Records ASA Treatment
07 Correspondence/Notices 6660 M-858ff Notice of Intent to Restrict Home Energy Allowance
07 Correspondence/Notices 5466 M-927 Loss of Eligibility for TITLE IVE ADC-FC Assistance Notice of
07 Correspondence/Notices 6261 M5A Notice of Expiration of Food Stamps Benefits
07 Correspondence/Notices 5442 MAP 2087A Denial of Your Medical Assistance Application Notice of
07 Correspondence/Notices 5419 MAP 2087U Action Notice: App for MA Buy-In Prgrm MAP-258K replaces
07 Correspondence/Notices 5435 MAP Continuation of Your Medicaid Eligibility Recertification
07 Correspondence/Notices 7847 MAP- 909H DAB-Managed Long Term Care Renewal Notification
07 Correspondence/Notices 7851 MAP- 931U Excess Income Program/Family Health Plus Selection Letter
07 Correspondence/Notices 6204 MAP- Facts Sheet For Submission of Documentation for Reimburs
07 Correspondence/Notices 5457 MAP-153A Notice to Hospital of Patient Ineligibility Code 2
07 Correspondence/Notices 6225 MAP-2 Notice of Acceptance of Your MA Appt w Limited Coverage
07 Correspondence/Notices 6289 MAP-2001Notice of Acceptance of Your Medicaid Application Pregnancy
07 Correspondence/Notices 6290 Map-2006 Notice of Eligibility for Medical Assistance
07 Correspondence/Notices 6291 MAP-2010F Notice of Denial on Your Nursing Home Conversion Request
07 Correspondence/Notices 5422 MAP-2016B Appointment Notice of
07 Correspondence/Notices 5495 MAP-2025 Recertification Appointment, Notice of
07 Correspondence/Notices 7144 MAP-202B Important Notice to Food Stamp Recipient /former MAP-2002B
07 Correspondence/Notices 6888 MAP-2033E Notice of Retroactive Eligibility (Fair Hearing)
07 Correspondence/Notices 5459 MAP-2052A Inability to Process Referral Notice of
07 Correspondence/Notices 6947 MAP-2067A Notice Of Use Of Old Excess Income Amount-Home Care
07 Correspondence/Notices 6948 MAP-2070M Notice Of Intent Change Contribution To Chronic Care Costs
07 Correspondence/Notices 6893 MAP-2070V Notice to Community Spouse re Income
07 Correspondence/Notices 6784 MAP-2083G Notice of Decision on Reimbursement of Medical Bills
07 Correspondence/Notices 5436 MAP-2087 Decision of Your Medical Assistance Application Notice of
07 Correspondence/Notices 5928 MAP-2087D Decision to Terminate your MA FT Return FFR Statement
07 Correspondence/Notices 5458 MAP-2087F Notice of Decision MA Application MA FHP FPBP Denial
07 Correspondence/Notices 5929 MAP-2087H MA Discontinue Notice Child 6-18 was Eligible at 133 percent
07 Correspondence/Notices 5418 MAP-2087K Acceptance of Your MA Application Institutional Services
07 Correspondence/Notices 5793 MAP-2087M Notice of Intent to Change Amount Your Net Available Mo.
07 Correspondence/Notices 7178 MAP-2087Q Notice Of Decrease To Your MA Eligibility Level (RVI)
07 Correspondence/Notices 5930 MAP-2087R Intent to Discontinue Medical Assistance Notice of
07 Correspondence/Notices 6945 MAP-2087U Action Notice: App for MA Buy-In Prgrm MAP-258K replaces
07 Correspondence/Notices 5417 MAP-2088H Acceptance of Your Medicaid Application Pregnancy Notice
07 Correspondence/Notices 5521 MAP-2088J Notice of Your MA Recertification Eligibility Decision
07 Correspondence/Notices 6929 MAP-2088M Notice of Accept. MA with Limited Cov. (Spousal Refusal)
07 Correspondence/Notices 5479 MAP-2088U Medical Assistance Disability Determination Notice of
07 Correspondence/Notices 6896 MAP-2088Y Notice of Decision on your MA Application Full Coverage
07 Correspondence/Notices 6924 MAP-2089D Notice Concerning Your Zero NAMI Request
07 Correspondence/Notices 6925 MAP-2089E Notice of Acceptance - Medicaid Application
07 Correspondence/Notices 5795 MAP-2094V Request to get notices in English/Spanish or English Only
07 Correspondence/Notices 6765 MAP-2097B Notice Change Full MA Coverage to FHP FNP Parent
07 Correspondence/Notices 6766 MAP-2097C Notice: Change Full MA Coverage 2 FHP Spenddown-Elig or FP
07 Correspondence/Notices 6767 MAP-2097D Notice Change Full MA Coverage to FHP SCC-100 percent
07 Correspondence/Notices 6768 MAP-2097E Notice of Change -turning 19 MA to Family Health Plus
07 Correspondence/Notices 6769 MAP-2097F Notice of Change from Family Health Plus to MA
07 Correspondence/Notices 6770 MAP-2097G Notice to Remain in Family Health Plus
07 Correspondence/Notices 6772 MAP-2097H Notice of Change from Full MA to Excess Income
07 Correspondence/Notices 6774 MAP-2097M Notice of Denial of Your Family Health Plus Application
07 Correspondence/Notices 6775 MAP-2097N Notice of Denial of Your Family Health Plus Application
07 Correspondence/Notices 6747 MAP-2097P Notice of Denial of Fam Health Plus
07 Correspondence/Notices 6777 MAP-2097Q Notice of FHP Acceptance of Health Insurance Application
07 Correspondence/Notices 6778 MAP-2097R Notice of FHP Acceptance of Health Insurance Application
07 Correspondence/Notices 6780 MAP-2097U Notice of FHP Acceptance of Health Insurance Application
07 Correspondence/Notices 5433 MAP-2100C Conference Review Results Notice of
07 Correspondence/Notices 5452 MAP-2120B Eligibility for Medical Assistance Home Care Serv Notice of
07 Correspondence/Notices 5451 MAP-2151B Notice Of Decision Regarding Your Emergency MA Coverage
07 Correspondence/Notices 5486 MAP-2158D Notice to MA BuyIn Appl W Xcess Income MAP-258D replaces
07 Correspondence/Notices 6946 MAP-2158K Action Notice: MA Premium Pymnt Prgrm MAP-258K replaces
07 Correspondence/Notices 5485 MAP-2161B Notice to a Legally Respon Relative of a Medicaid Recipient
07 Correspondence/Notices 5456 MAP-2985 Hospital of Medicaid Decision Notification to
07 Correspondence/Notices 8487 MAP-316M Notice of Home Health Agency of AID Continuing Directive
07 Correspondence/Notices 7934 MAP-480M Notice of Disenrollment From A Medicaid Managed Care Plan
07 Correspondence/Notices 6921 MAP-635A Mail Renewal Notice/CHP B Referral
07 Correspondence/Notices 8156 MAP-635R Return of Late Mail Renewal Application
07 Correspondence/Notices 7848 MAP-648Z Relocation Referral Transmittal
07 Correspondence/Notices 7933 MAP-751R Request to Update Address information on file
07 Correspondence/Notices 7931 MAP-751T Verification of New Address or Request to Close Case
07 Correspondence/Notices 5517 MAP-992A Excess Income Program Decision Notice
07 Correspondence/Notices 6198 MAP/E C909 Dear Former SSI Beneficiary
07 Correspondence/Notices 6312 MAP/E L631 Notice of Auth Participation in Long Term Health Care
07 Correspondence/Notices 6259 MAP/EC1249 You did not include the following information
07 Correspondence/Notices 6227 MAP2067 Notice of Continued Use of Prior Excess Income
07 Correspondence/Notices 1722 MDR appointment Notice
07 Correspondence/Notices 6293 MEP-2155D Denial of Request for Reimbursement of pd med bills
07 Correspondence/Notices 6294 MEP-992 Acknowledgement of Inquiry
07 Correspondence/Notices 5483 Miscellaneous Notice
07 Correspondence/Notices 7857 MKB-83W MKB Request for Case Review
07 Correspondence/Notices 9065 New Providers
07 Correspondence/Notices 5038 Notice of Intent to Change or Continue any kind
07 Correspondence/Notices 5039 Notice of Intent to Discontinue any kind
07 Correspondence/Notices 6319 Notice of Intent to Suspend Child Care Allowance
07 Correspondence/Notices 6642 Notice of Issuance of Advance to Prevent Eviction & Int to Rest Shel
07 Correspondence/Notices 6603 Notice of Reduction of PA.& or FS benefits due to receipt of SSI
07 Correspondence/Notices 7885 OCSE Appointment Notice
07 Correspondence/Notices 7039 OCSE CSET Assignor Notice regards petition court date
07 Correspondence/Notices 7040 OCSE Letter Notice To Report To Family Court
07 Correspondence/Notices 8875 OCSE STEP Non Compliance Letter (WISE System)
07 Correspondence/Notices 8748 OCSE-189 Restraining Notice
07 Correspondence/Notices 8895 OCSE-277e OCSE Site Change Letter
07 Correspondence/Notices 8940 OCSE-301 Rescheduled Appointment Confirmation Letter
07 Correspondence/Notices 6910 Official Correspondence from Social Security Administration
07 Correspondence/Notices 6908 Official Correspondence from the Child Support Enforcement Unit
07 Correspondence/Notices 6909 Official Correspondence from the New York State Department of Labor
07 Correspondence/Notices 9063 Placement Notice
07 Correspondence/Notices 9005 Procedure Confirmation Letter
07 Correspondence/Notices 7089 RA-3310 Owner's Report Cert or Notice of Fuel Cost Adjust Elig
07 Correspondence/Notices 7098 RED-12 Face to face recert appointment notice Tier II shelter
07 Correspondence/Notices 6670 RED-2 Home Visit Appointment Deferred Recertification
07 Correspondence/Notices 5042 Reinstatement Notice of
07 Correspondence/Notices 5510 Required Corrective Action on State Quality Control FindingsNotification of
07 Correspondence/Notices 6247 Rescheduled Appointment
07 Correspondence/Notices 5044 Rescheduling Letter
07 Correspondence/Notices 8220 RTSC NYCWAY-CASAC Code Information
07 Correspondence/Notices 7902 SSA Notice of Decision Unfavorable HA-L76-OP2
07 Correspondence/Notices 7901 SSA Notice of Hearing HA-L83
07 Correspondence/Notices 5838 SSA-11BK A Reminder to Payee Applicants
07 Correspondence/Notices 6200 SSA-1207 Disability Hearing Officer's Decision
07 Correspondence/Notices 6182 SSA-135-EP Advanced Notice of Termination of Childs Benefits
07 Correspondence/Notices 6242 SSA-2118 u2 Request for Documents or Information
07 Correspondence/Notices 6345 SSA-5002 Report of Contact
07 Correspondence/Notices 6199 SSA-53-EP Did You Forget Recouping overpaid SSI Benefits
07 Correspondence/Notices 6545 SSA-53-EP Notice of Payment Due
07 Correspondence/Notices 5023 SSA-800B Additional information about your claim
07 Correspondence/Notices 6296 SSA-8203-BK Your Reporting Responsibilities
07 Correspondence/Notices 6297 SSA-L305 Record of Conversation
07 Correspondence/Notices 6298 SSA-L4201 Request for Information About Wages
07 Correspondence/Notices 7798 SSA-L442 Notice of Disapproved Claim SSDI
07 Correspondence/Notices 7154 SSA-L676 SSN Card Denial Notice
07 Correspondence/Notices 6161 SSA-L8030 Supplemental Security Income - Notice of Disapproved Claim
07 Correspondence/Notices 6044 SSA-L8165 Important Notice - New SSI Rules on Eligibility
07 Correspondence/Notices 6231 SSA-L8171-U-3 Notice of Overpayment
07 Correspondence/Notices 7417 SSI Appeal Letter
07 Correspondence/Notices 7416 SSI Denial Letter
07 Correspondence/Notices 6915 Statement from Provider of Coverage Health Insurance
07 Correspondence/Notices 6295 Supplement to Claim of Person Outside the United States
07 Correspondence/Notices 8081 Treating Physician's Wellness Plan Report
07 Correspondence/Notices 7407 Vendor Client case notes letters notices forms for PRIDE client
07 Correspondence/Notices 5799 Verification of School Attendance
07 Correspondence/Notices 6912 Veteran's Administration's Official Correspondence
07 Correspondence/Notices 1656 W-102 Notification to Participant of New Worker
07 Correspondence/Notices 7546 W-103D Special Assessment Letter
07 Correspondence/Notices 6082 W-106E Notice of Decision on Returned Check
07 Correspondence/Notices 6793 W-113A Documentation Request Form-for Additional Allowances
07 Correspondence/Notices 1290 W-113K Documentation Required
07 Correspondence/Notices 7010 W-113K S Documentation Requirements Spanish
07 Correspondence/Notices 6952 W-116 S Notice of Approval Request Educat or Training Spanish
07 Correspondence/Notices 6745 W-116G Notice of Job Interview
07 Correspondence/Notices 6951 W-116J Notice of Approval Request Educational or Training Program
07 Correspondence/Notices 6953 W-116R Notice of Denial Request Educational or Training Program
07 Correspondence/Notices 6954 W-116R S Notice of Denial Request Educat or Training Spanish
07 Correspondence/Notices 7011 W-116T Notice of Training Alternative Program
07 Correspondence/Notices 7012 W-116T S Notice of Training Alternative Program Spanish
07 Correspondence/Notices 7019 W-119 Request for Contact on a Mailed Faxed Application
07 Correspondence/Notices 6791 W-120K Food Stamps- Request for Contact or Missed Interview
07 Correspondence/Notices 7942 W-126E Food Stamp Telephone Recertification Reminder Notice
07 Correspondence/Notices 6091 W-129EE Notice of Intent to Reduce Food Stamp Benefits
07 Correspondence/Notices 6730 W-129S Notice of Intent to Discontinue Food Stamps Benefits 4sides
07 Correspondence/Notices 6299 W-130H Notice of Forwarding of Application
07 Correspondence/Notices 6075 W-130Y Notice of Adverse Action - Reduc of Allot Recover Overissuance
07 Correspondence/Notices 8227 W-131WW Notice of Able Bodied Adult without Dependents Status
07 Correspondence/Notices 1648 W-132EE Notice of Transfer of Food Stamp Case
07 Correspondence/Notices 6300 W-132S Documentation Required-Changes in Household Circumstances
07 Correspondence/Notices 6303 W-133 Notice of Expiration of FS Benefits SSI or Homebound Recipients
07 Correspondence/Notices 6301 W-133U Notification of Forwarding of FS Application to Another Office
07 Correspondence/Notices 6302 W-133V Notice of Recertification
07 Correspondence/Notices 7102 W-134A Demand Letter for Over issuance
07 Correspondence/Notices 7140 W-134N Food Stamp Claims Acknowledgement Of Payment Received
07 Correspondence/Notices 5045 W-134R We received your recent correspondence
07 Correspondence/Notices 1298 W-137A Request for Additional Allowance
07 Correspondence/Notices 1306 W-137B Acceptance-Denial of Request for Additional Allowance
07 Correspondence/Notices 8297 W-137G Notice of Additional Food Stamps
07 Correspondence/Notices 8337 W-137H Outcome of Review for Restored Food Stamp Benefits
07 Correspondence/Notices 6304 W-138AA Application for Food Stamp Benefits Can Be Processed
07 Correspondence/Notices 6305 W-138B Informational Notice to Able-Bodied FS Work Restraints
07 Correspondence/Notices 6658 W-138D Notification of Work Requirements & Right to Contest or FS
07 Correspondence/Notices 6639 W-138E Call-In Letter for an ABAWD
07 Correspondence/Notices 7013 W-138E S Call-In Letter for ABAWD Spanish
07 Correspondence/Notices 6640 W-138H Mandatory Appointment Notice-NPA FS ABAWD Participant to ESP
07 Correspondence/Notices 5033 W-138T Information About an Expedited Food Stamp Interview
07 Correspondence/Notices 6077 W-138TT Notice of Application Interview Appointment
07 Correspondence/Notices 6313 W-139E Notice of DASIS Benefits and Services
07 Correspondence/Notices 6644 W-140JJ Appointment Notice
07 Correspondence/Notices 7014 W-140JJ S Appointment Notice Spanish
07 Correspondence/Notices 1350 W-145HH Decision Notice: Assistance to Meet an Immediate Need
07 Correspondence/Notices 6643 W-145V Notice of Intent to Restrict Rent
07 Correspondence/Notices 1738 W-145VV Notice of Change in Cash Payment for Family Assistance Cases
07 Correspondence/Notices 6046 W-145W Important Notice about your temporary shelter accommodations
07 Correspondence/Notices 6647 W-146C Notice of Intent to Issue an Advance Allowance for Rent
07 Correspondence/Notices 6090 W-146G Notice of Intent to Issue an advance allowance for rent
07 Correspondence/Notices 6066 W-146Q Likelihood of Becoming a Public Charge
07 Correspondence/Notices 7105 W-158D Notification of Accounts Receivable
07 Correspondence/Notices 7015 W-186 Division of Fair Hearing Rivera Request Receipt
07 Correspondence/Notices 7404 W-186A Rivera Request Response
07 Correspondence/Notices 5430 W-2-112 Change Notice of
07 Correspondence/Notices 6509 W-205 Cancellation of Public Assistance Check
07 Correspondence/Notices 6648 W-273BB Notice of Change in the Way Child Care Ben Are Paid for Ind
07 Correspondence/Notices 6940 W-273V Provider approval and child enrollment notice
07 Correspondence/Notices 6649 W-273Y Notice of Change in the Day Child Care Ben Are Paid for Ind
07 Correspondence/Notices 6958 W-273YY Notice Of Intent To Discontinue Child Care Benefits
07 Correspondence/Notices 8849 W-280C Notice to Report to Family Court
07 Correspondence/Notices 7561 W-280H Appointment to OCSE
07 Correspondence/Notices 6315 W-29 Notice to Applic Recip Regarding Third Party Health Insurance
07 Correspondence/Notices 6226 W-296A Notice of Appointment
07 Correspondence/Notices 6651 W-299G Notification of Continuing Medical Coverage
07 Correspondence/Notices 6548 W-328C Notice to Client Initiation of Two Party Rent payment
07 Correspondence/Notices 7749 W-331A Appeal Call-In Letter Mandatory
07 Correspondence/Notices 7395 W-331A Disability Appeals Unit Mandatory Assessment Interview
07 Correspondence/Notices 8843 W-331H Disability Services Program Initial Assessment Interview
07 Correspondence/Notices 8113 W-333T Drug Treatment Record and Confidential HIV Related Information
07 Correspondence/Notices 7330 W-489A Letter of Intro. Referral to Comm. SRO or Transition Hotel
07 Correspondence/Notices 7133 W-500CC Mandatory Return Appointment
07 Correspondence/Notices 7134 W-500CC S Mandatory Return Appointment Spanish
07 Correspondence/Notices 7016 W-500DD Training Assessment Group Appointment Verification
07 Correspondence/Notices 7234 W-500M Notice to Report Employment Information
07 Correspondence/Notices 7662 W-502 Referral to Back to Work BTW Vendor
07 Correspondence/Notices 7046 W-502 Referral to Skills Assessment and Placement Vendor
07 Correspondence/Notices 6956 W-507A Notice of Applicant Self-Enrollment Training or Educat Pgm
07 Correspondence/Notices 6949 W-531 Important Information About Your Application
07 Correspondence/Notices 7047 W-532A Conciliation Notification
07 Correspondence/Notices 7048 W-532B Conciliation Notification For Activity Period Continued
07 Correspondence/Notices 7135 W-532C Conciliation Notification For Activity Period Continued
07 Correspondence/Notices 0968 W-532D Notice of Employability
07 Correspondence/Notices 7559 W-533H WeCare Mandatory Return Appointment
07 Correspondence/Notices 6316 W-538B Notice to Medical Assistance Program
07 Correspondence/Notices 0872 W-538C Medical Provider Appointment
07 Correspondence/Notices 0087 W-538C Medical Provider Appointment
07 Correspondence/Notices 6941 W-560CC Notice: Eligibility for Transitional Child Care Benefits
07 Correspondence/Notices 6959 W-560DD Notice Of ineligibility Transitional Child Care Bene
07 Correspondence/Notices 6960 W-560EE Notice Of Intent To Change Child Care Benefits
07 Correspondence/Notices 6961 W-560FF Notice Of Delinquent Family Share Child Care Benefits
07 Correspondence/Notices 5028 W-568W Client's Acknowledgment of Changes in Ben PA-FS-MA
07 Correspondence/Notices 7017 W-573XX BEGIN Program Referral Letter
07 Correspondence/Notices 1672 W-574Z Notification of Work Requirement & Right to Contest
07 Correspondence/Notices 6654 W-576X Repayment Letter
07 Correspondence/Notices 6224 W-576Y NOI Data Entry Request for Employment Non-Compliance
07 Correspondence/Notices 6233 W-576Z Notice of Right to Appeal
07 Correspondence/Notices 7106 W-585P 1 orTLEP-30 Client Address Information Request TLEP
07 Correspondence/Notices 7111 W-588Q or RED-500 Not at Home Notice
07 Correspondence/Notices 8270 W-590QQ IREA Liens and Recovery Agreement letter
07 Correspondence/Notices 8271 W-590RR IREA Liens and Recovery Bill
07 Correspondence/Notices 8273 W-590TT IREA Liens and Recovery Deal Is Off letter
07 Correspondence/Notices 8272 W-596B IREA Liens and Recovery Client Lien Amount letter
07 Correspondence/Notices 6515 W-603K Client Notification of Transfer
07 Correspondence/Notices 1434 W-636 Notice of Special Grant
07 Correspondence/Notices 1704 W-700E School Attendance Verification Letter
07 Correspondence/Notices 6234 W-701B Notice of Temp. Removal of Child & Right to Hearing
07 Correspondence/Notices 6049 W-710 Income Maintenance Report of Action Taken
07 Correspondence/Notices 6317 W-723 Facsimile Transmission
07 Correspondence/Notices 8057 W-75 Senior-Works Appointment Letter
07 Correspondence/Notices 7332 W-897A Client Referral Notice to Community Based Organizations
07 Correspondence/Notices 7333 W-897D Notice of Eligibility for HASA Program Admission
07 Correspondence/Notices 7065 W-897G Client Services- Receipt of Documents to Establish Elig
07 Correspondence/Notices 7043 W-901 Notice of Food Stamp Recertification Appointment
07 Correspondence/Notices 7044 W-901 S Notice of FS Recertification Appointment Spanish
07 Correspondence/Notices 7045 W-901A Telephone Recertification Contact Information
07 Correspondence/Notices 8007 W-902J Visit Notification
07 Correspondence/Notices 8596 W-902X Notice to Report Employment or School Attendance
07 Correspondence/Notices 8597 W-902Y Declaration of Employment and/or School Attendance
07 Correspondence/Notices 6318 W-904DD Notice To Recipients
07 Correspondence/Notices 1454 W-908CC Notice of Rescheduled Appointment
07 Correspondence/Notices 7557 W-908D Data Sheet
07 Correspondence/Notices 7558 W-908E Automated Telephone Recertification
07 Correspondence/Notices 1462 W-908T Recertification Appointment Letter
07 Correspondence/Notices 1466 W-908VV Referral Appointment Letter
07 Correspondence/Notices 1582 W-908W Recertification Appointment Letter-Spanish
07 Correspondence/Notices 6813 W-912HH Request for Info from Employer
07 Correspondence/Notices 1562 W-912HH Request for Information From Employer
07 Correspondence/Notices 6235 W123GG Notice to Bring in Photo ID in order to get FS Benefits
07 Correspondence/Notices 6207 W519E Finger Imaging Notice
07 Correspondence/Notices 6230 W612 Notice of Intent Change Continue or Benefits PA-FS and MA
07 Correspondence/Notices 6237 W701C Protective Custody Emergency Removal
07 Correspondence/Notices 8599 Wellness Plan Follow-UP WeCare
07 Correspondence/Notices 7121 XLO114 22 month time limit letter
08 Inter/IntraAgency Correspondence 6631 "Fraud Announcements
08 Inter/IntraAgency Correspondence 8015 "Scatter-site ll Case Assessment by Provider
08 Inter/IntraAgency Correspondence 6320 ACD 1039 Medical Referral or Referido Medico
08 Inter/IntraAgency Correspondence 7024 ACD-1122 Payment to Provider for Child Care
08 Inter/IntraAgency Correspondence 1694 ACS Referral Statement
08 Inter/IntraAgency Correspondence 8259 ACS/CCSS Program/Provider Packet
08 Inter/IntraAgency Correspondence 5047 ADC-BEGIN Fair Hearing Action Sheet
08 Inter/IntraAgency Correspondence 5962 Application Interview Referral Form
08 Inter/IntraAgency Correspondence 9019 Application to Replace Permanent Resident Card
08 Inter/IntraAgency Correspondence 9018 APS COLA increase notification to Field Office
08 Inter/IntraAgency Correspondence 9016 APS Rep Payee application approval notification to Field Office
08 Inter/IntraAgency Correspondence 9015 APS Rep Payee application notification to Field Office
08 Inter/IntraAgency Correspondence 9017 APS Termination of Rep Payee services notification to Field Office
08 Inter/IntraAgency Correspondence 8265 b-83 Client Locate Letter Monies Due
08 Inter/IntraAgency Correspondence 8266 b-83A Client Locate Letter Moines Due Over 2 Years
08 Inter/IntraAgency Correspondence 1586 BEV Compliance Letter
08 Inter/IntraAgency Correspondence 8425 BFI- Arrest Notification Form
08 Inter/IntraAgency Correspondence 8447 BFI-101 Return Appointment to
08 Inter/IntraAgency Correspondence 8451 BFI-131D Social Security Number Validation
08 Inter/IntraAgency Correspondence 8449 BFI-132a Signature and Witness List
08 Inter/IntraAgency Correspondence 8453 BFI-132B Summary of Fraud Activity
08 Inter/IntraAgency Correspondence 8426 BFI-132G Authorization to Release Info
08 Inter/IntraAgency Correspondence 8443 BFI-135 Request to Change information
08 Inter/IntraAgency Correspondence 8427 BFI-138 DFRP FSCAR Referral
08 Inter/IntraAgency Correspondence 8423 BFI-142 Agency Witness Sheet
08 Inter/IntraAgency Correspondence 8445 BFI-145 Required Statistical Action
08 Inter/IntraAgency Correspondence 8446 BFI-145 Restitution Memorandum
08 Inter/IntraAgency Correspondence 8442 BFI-150A Request for Restitution
08 Inter/IntraAgency Correspondence 8444 BFI-151 Request for Marriage Records
08 Inter/IntraAgency Correspondence 8452 BFI-152 Summary of Civil Action
08 Inter/IntraAgency Correspondence 8435 BFI-156 Original Rent Checks request
08 Inter/IntraAgency Correspondence 8454 BFI-160 Summary of IPV Act and Exhibits
08 Inter/IntraAgency Correspondence 8424 BFI-161 Arrest Data
08 Inter/IntraAgency Correspondence 8421 BFI-163 Access to Records for MA services
08 Inter/IntraAgency Correspondence 8428 BFI-200 Transmittal to FSCAR
08 Inter/IntraAgency Correspondence 7037 BFI-21B Report of Investigation
08 Inter/IntraAgency Correspondence 8430 BFI-22E Chronological Developments
08 Inter/IntraAgency Correspondence 8429 BFI-25D Child Care Provider Call in letter
08 Inter/IntraAgency Correspondence 8434 BFI-33 Notice of Absent Parent Information
08 Inter/IntraAgency Correspondence 8455 BFI-40 Voluntary Restitution
08 Inter/IntraAgency Correspondence 8450 BFI-42 Sign in Sheet
08 Inter/IntraAgency Correspondence 8420 BFI-4450 OMIG Referral
08 Inter/IntraAgency Correspondence 8440 BFI-45 Report of Interview
08 Inter/IntraAgency Correspondence 8938 BFI-BFI/SNAP-CR to Viewer
08 Inter/IntraAgency Correspondence 8935 BFI-Intake and Referral Division
08 Inter/IntraAgency Correspondence 8937 BFI-Investigations Division
08 Inter/IntraAgency Correspondence 8468 BFI-Match Information
08 Inter/IntraAgency Correspondence 8432 BFI-Medicaid IG - Restriction Referral Form
08 Inter/IntraAgency Correspondence 8936 BFI-Medicaid Investigations Division
08 Inter/IntraAgency Correspondence 8433 BFI-Miranda Warning
08 Inter/IntraAgency Correspondence 8058 Biopsychosocial Evaluation
08 Inter/IntraAgency Correspondence 8059 Biopsychosocial Evaluation Specialties
08 Inter/IntraAgency Correspondence 8289 CA Application Package/CA FFR Package HASA
08 Inter/IntraAgency Correspondence 8630 CAS-301 WeCare Functional Capacity Outcome Appointment
08 Inter/IntraAgency Correspondence 8632 CAS-316A WeCare Employment Program Services
08 Inter/IntraAgency Correspondence 8633 CAS-316E WeCare Education/Training Services
08 Inter/IntraAgency Correspondence 8634 CAS-316T WeCare Rehabilitation Program Services
08 Inter/IntraAgency Correspondence 8713 CAS-316W WeCare New Service Provider
08 Inter/IntraAgency Correspondence 8631 CAS-322 WeCare Assessment for a Clinical Review
08 Inter/IntraAgency Correspondence 8922 CAS-326 Vocational Rehabilitation Services Location Change (WeCARE)
08 Inter/IntraAgency Correspondence 9094 CAS-327 Mandatory Wellness Plan Follow-Up Telephone Appointment
08 Inter/IntraAgency Correspondence 9106 CAS-331 WeCare for a Clinical Review
08 Inter/IntraAgency Correspondence 9107 CAS-334 WeCare for a Biopsychosocial Evaluation
08 Inter/IntraAgency Correspondence 8850 CAS-499 Appointment for Evaluation for a Work Activity
08 Inter/IntraAgency Correspondence 8410 CAS-DSP Additional Info Packet
08 Inter/IntraAgency Correspondence 8074 CASAC Assessment Summary
08 Inter/IntraAgency Correspondence 5053 Case Involvement History Screen
08 Inter/IntraAgency Correspondence 7597 CAVU-Review Findings Centralized Alien Verification Unit
08 Inter/IntraAgency Correspondence 8286 CBO Referral Package/Documentation HASA
08 Inter/IntraAgency Correspondence 6390 Claims Prescreening Form
08 Inter/IntraAgency Correspondence 8075 Clinical Review Team CRT
08 Inter/IntraAgency Correspondence 0864 Closing Letter from Welfare Agency or Program
08 Inter/IntraAgency Correspondence 6195 Community Center Service Network Project Referral or Information
08 Inter/IntraAgency Correspondence 8061 Comprehensive Service Plans
08 Inter/IntraAgency Correspondence 8069 Comprehensive Service Plans Fully Employable
08 Inter/IntraAgency Correspondence 5054 Consent for Release of Medical Psychiatric Information
08 Inter/IntraAgency Correspondence 8070 Consents
08 Inter/IntraAgency Correspondence 7693 CS-101 Mandatory Return Appointment to ACS
08 Inter/IntraAgency Correspondence 8809 CS-1066 Mail in Recertification of Eligibility for Child Care Services
08 Inter/IntraAgency Correspondence 8810 CS-1066A Eligibility for Child Care Services
08 Inter/IntraAgency Correspondence 7695 CS-273UU Child Care Provider Income Verification Letter
08 Inter/IntraAgency Correspondence 8253 CS-574FF Proof of ID and Residency for Your Child Care Provider
08 Inter/IntraAgency Correspondence 1210 D & C Notice of PA Check Cancellation
08 Inter/IntraAgency Correspondence 5055 Department of Motor VehiclesTraffic Violations Report
08 Inter/IntraAgency Correspondence 7632 DHCR or for apt buildings w 6 units - New Apartment Rent
08 Inter/IntraAgency Correspondence 7189 DHS Client's Request for Rent Payment of EARP Supplement
08 Inter/IntraAgency Correspondence 7028 DHS-432G Medicaid Clearance Form
08 Inter/IntraAgency Correspondence 8062 Diagnostic Vocational Evaluation
08 Inter/IntraAgency Correspondence 7687 Document Receipt from Community Based Organization CBO
08 Inter/IntraAgency Correspondence 8752 Documentation re-establishing ABAWD eligibility
08 Inter/IntraAgency Correspondence 6008 Documentation Required for Eligibility Determination
08 Inter/IntraAgency Correspondence 8993 DOL-Data Match
08 Inter/IntraAgency Correspondence 0200 Drug or Alcohol Program Letter
08 Inter/IntraAgency Correspondence 7882 DSP SSA Forms
08 Inter/IntraAgency Correspondence 8312 DSP-Appeal Assessment Form
08 Inter/IntraAgency Correspondence 7884 DSP-ONLY Miscellaneous Document
08 Inter/IntraAgency Correspondence 1574 DSS-2221A Report of Suspected Child Abuse or Maltreatment
08 Inter/IntraAgency Correspondence 0988 DSS-2474 SSI Referral
08 Inter/IntraAgency Correspondence 5960 DSS-2633 Application for Emergency Assistance for Adults
08 Inter/IntraAgency Correspondence 0848 DSS-2640 Request for Services or DSS or VA Referral
08 Inter/IntraAgency Correspondence 5058 DSS-2846 Fair Hearing Disposition Notice of
08 Inter/IntraAgency Correspondence 1578 DSS-2921 Application for PA-MA-FS Benefits-Spanish
08 Inter/IntraAgency Correspondence 5477 DSS-2924P Medicaid WIC/Application for Pregnant Women Young Children
08 Inter/IntraAgency Correspondence 6529 DSS-2943 Individual or Family Services Plan
08 Inter/IntraAgency Correspondence 6322 DSS-2949 Personal Data Sheet Progress Report
08 Inter/IntraAgency Correspondence 6323 DSS-3021 AFDC or SSI Interagency Request
08 Inter/IntraAgency Correspondence 5994 DSS-3151 Commission for the Blind and Visually Handicapped Eye Report
08 Inter/IntraAgency Correspondence 8162 DSS-3603 Initial Assessment-Service Plan Review
08 Inter/IntraAgency Correspondence 5496 DSS-3608 Recertification Guide
08 Inter/IntraAgency Correspondence 6567 DSS-3668 Shelter Verification
08 Inter/IntraAgency Correspondence 5062 DSS-3722 Fair Hearing Update Data Entry Form
08 Inter/IntraAgency Correspondence 6019 DSS-3774 EPFT Benefits to be pulled - data entry form
08 Inter/IntraAgency Correspondence 5951 DSS-4002F Action Tkn on request for assist to meet immdat need
08 Inter/IntraAgency Correspondence 5968 DSS-414 Authoriz for Reimbursement of Interim Assist SSI Determination
08 Inter/IntraAgency Correspondence 5959 DSS-4148A Application
08 Inter/IntraAgency Correspondence 8750 DSS-4163 MOF/Submission Form
08 Inter/IntraAgency Correspondence 6871 DSS-4482-10 Fair Hearing Decision To Applicant
08 Inter/IntraAgency Correspondence 5060 DSS-457 Fair Hearing Schedule Notice of
08 Inter/IntraAgency Correspondence 1154 DSS-4571 Alcohol Substance Abuse Screening
08 Inter/IntraAgency Correspondence 1594 DSS-4571S Alcohol Substance Abuse Screening-Spanish
08 Inter/IntraAgency Correspondence 6554 DSS-4718 Race/Ethnic Code Data Entry Form
08 Inter/IntraAgency Correspondence 6325 DSS-649 PCAP Transmittal to City or DSS
08 Inter/IntraAgency Correspondence 6664 EBT-14 Referral to Fraud Investigation Fraud
08 Inter/IntraAgency Correspondence 7690 EBT-64 Customer Service ARU PIN Restriction Permission
08 Inter/IntraAgency Correspondence 5542 EC-23 WCB Notice of Decision
08 Inter/IntraAgency Correspondence 6327 Eligibility Interview Guide and Workbook
08 Inter/IntraAgency Correspondence 6749 EXP-53J Transitional Support Payment Income Comparison Worksheet
08 Inter/IntraAgency Correspondence 7916 EXP-75 Grant Diversion Program Letter
08 Inter/IntraAgency Correspondence 8163 EXP-85MM Notice to Report to Center
08 Inter/IntraAgency Correspondence 8224 EXP-86D Notice of Decision on HRA Bonus Payment
08 Inter/IntraAgency Correspondence 8178 Fair Hearing Added EEPS Documents
08 Inter/IntraAgency Correspondence 1190 Fair Hearing Aid-To-Continue Documentation
08 Inter/IntraAgency Correspondence 8177 Fair Hearing Appellant Information
08 Inter/IntraAgency Correspondence 8194 Fair Hearing Centralized Resolution Documents
08 Inter/IntraAgency Correspondence 1186 Fair Hearing Decision
08 Inter/IntraAgency Correspondence 5781 Fair Hearing History Sheet
08 Inter/IntraAgency Correspondence 7468 Fair Hearing Packet 98A Fair Hearing Packet
08 Inter/IntraAgency Correspondence 7467 Fair Hearing Packet Aid To Continue ATC
08 Inter/IntraAgency Correspondence 7790 Fair Hearing Packet Compliance Review
08 Inter/IntraAgency Correspondence 8305 Fair Hearing Packet Home Care
08 Inter/IntraAgency Correspondence 7791 Fair Hearing Packet Non-Cash Assistance Food Stamp
08 Inter/IntraAgency Correspondence 7801 Fair Hearing Packet Rivera Processing
08 Inter/IntraAgency Correspondence 7465 Fair Hearing Packet Rivera request issues
08 Inter/IntraAgency Correspondence 8941 Fair Hearing Resolution Statement
08 Inter/IntraAgency Correspondence 5061 Fair Hearing Update Data Entry
08 Inter/IntraAgency Correspondence 7081 Family Permanency Conference Service Plan Agreement
08 Inter/IntraAgency Correspondence 8658 Federal Disability Form WeCare
08 Inter/IntraAgency Correspondence 8306 FIA-1004 Recoupment Overpayment Worksheet
08 Inter/IntraAgency Correspondence 8307 FIA-1004a Recoupment Action History Sheet
08 Inter/IntraAgency Correspondence 8301 FIA-1018 Over the Counter Card Cancellation
08 Inter/IntraAgency Correspondence 8299 FIA-1021 Notice of Able-Bodied Adult without Dependents (ABAWD) Status
08 Inter/IntraAgency Correspondence 8753 FIA-1021a Notice of Need to Reestablish ABAWD Eligibility
08 Inter/IntraAgency Correspondence 8751 FIA-1021b Declaration of Job Search Activities
08 Inter/IntraAgency Correspondence 8877 FIA-1021c Appointment Notice to Work Experience
08 Inter/IntraAgency Correspondence 8793 FIA-1021D Able-Bodied Adult without Dependents Compliance Notice
08 Inter/IntraAgency Correspondence 8878 FIA-1021e Able-Bodied Adult Without Dependents Appointment Notice
08 Inter/IntraAgency Correspondence 8879 FIA-1021h Notice of Incorrect Mailing
08 Inter/IntraAgency Correspondence 8828 FIA-1021i Notice of an Offer of Work Activity
08 Inter/IntraAgency Correspondence 8880 FIA-1021j Appointment Notice to Work (ABAWD)
08 Inter/IntraAgency Correspondence 8862 FIA-1021K Offer of Work to an Able-Bodied Adult Without Dependents
08 Inter/IntraAgency Correspondence 9026 FIA-1021L Cancellation of Your Work Experience Program
08 Inter/IntraAgency Correspondence 9027 FIA-1021M Cancellation of Your Appointment
08 Inter/IntraAgency Correspondence 8458 FIA-1056 Action Taken for Replacement of Food Purchased with FS
08 Inter/IntraAgency Correspondence 8492 FIA-1059 Replacement of Common Benefit Identification Card
08 Inter/IntraAgency Correspondence 8659 FIA-1068 Notice to Individuals Who Entered the United States
08 Inter/IntraAgency Correspondence 8629 FIA-1076 Important Notice to Participants Re: Incorrect NOI.
08 Inter/IntraAgency Correspondence 8680 FIA-1084 Statewide Clearance Contact
08 Inter/IntraAgency Correspondence 8946 FIA-1103a Conciliation Notification Demonstrated Compliance
08 Inter/IntraAgency Correspondence 8947 FIA-1103b Conciliation Notification for Activity Period Continued
08 Inter/IntraAgency Correspondence 8948 FIA-1103c Conciliation Notification for Activity Period Discontinued
08 Inter/IntraAgency Correspondence 9058 FIA-1116 Referral to Job Center for Application Interview
08 Inter/IntraAgency Correspondence 9059 FIA-1124 Notice of Missed Cash Assistance Appointment
08 Inter/IntraAgency Correspondence 9054 FIA-1126 Notice of Absence From Assignment
08 Inter/IntraAgency Correspondence 8138 Final Notice Fair Hearing Compliance
08 Inter/IntraAgency Correspondence 9076 Fire Department Report
08 Inter/IntraAgency Correspondence 5067 Fraud Alert
08 Inter/IntraAgency Correspondence 8288 FS Only Package HASA
08 Inter/IntraAgency Correspondence 5068 HA-501-U5 Hearing by Administrative Law Judge Request for
08 Inter/IntraAgency Correspondence 6328 HA-520-U5 Request for Review of Hearing Decision
08 Inter/IntraAgency Correspondence 7974 HA-L32 Electronic Disability Claims Processing
08 Inter/IntraAgency Correspondence 7683 HASA CASAC Assessment
08 Inter/IntraAgency Correspondence 7684 HASA Case Record
08 Inter/IntraAgency Correspondence 7685 HASA Case Transfer
08 Inter/IntraAgency Correspondence 9057 HASA CBCFA Decision Email
08 Inter/IntraAgency Correspondence 7680 HASA CBCFA Package
08 Inter/IntraAgency Correspondence 8667 HASA Child Care Provider Enrollment Package
08 Inter/IntraAgency Correspondence 7888 HASA EPU-Emergency Placement Unit Package
08 Inter/IntraAgency Correspondence 8600 HASA Housing Case Conference
08 Inter/IntraAgency Correspondence 8251 HASA Incident Report
08 Inter/IntraAgency Correspondence 8250 HASA Legally-Exempt Child Care Forms
08 Inter/IntraAgency Correspondence 7682 HASA Mental Health Assessment
08 Inter/IntraAgency Correspondence 8140 HASA Referral Letter
08 Inter/IntraAgency Correspondence 8348 HASA Restricted Access Letter
08 Inter/IntraAgency Correspondence 7681 HASA ServiceLine Package
08 Inter/IntraAgency Correspondence 8601 HASA Transportation Request Packages for Out-of-City Moves
08 Inter/IntraAgency Correspondence 7877 HASA-HMK HASA Homemaking Archive
08 Inter/IntraAgency Correspondence 8342 HCSP – 710C Request for Notice of Intent
08 Inter/IntraAgency Correspondence 6331 HCSP-3001 CASA-MEU Information Form Soc worker sta
08 Inter/IntraAgency Correspondence 8527 HCSP-3009 Reauthorization Package Renewal Reminder
08 Inter/IntraAgency Correspondence 8004 HCSP-710B Home Care Services Program Intake Form
08 Inter/IntraAgency Correspondence 8200 HCSP-711B HCAPS Referral Notices
08 Inter/IntraAgency Correspondence 8201 HCSP-711C HCHASA Referral Notices
08 Inter/IntraAgency Correspondence 8202 HCSP-711E HC Incomplete Application
08 Inter/IntraAgency Correspondence 6244 HDU Diversion Weekly Reporting Form
08 Inter/IntraAgency Correspondence 6243 HDU Rental Assistance Approval or Denial Form
08 Inter/IntraAgency Correspondence 6568 HHC 50-287 Special Application for a Copy of a Birth Certificate
08 Inter/IntraAgency Correspondence 6185 HHC-884 Application for Metropolitan Health Plan or HMO
08 Inter/IntraAgency Correspondence 5070 History Sheet any kind
08 Inter/IntraAgency Correspondence 8992 Home Care Reauthorization Packet
08 Inter/IntraAgency Correspondence 8991 Home Care Recertification/Reauthorization Packet
08 Inter/IntraAgency Correspondence 8076 Home Visit Documentation
08 Inter/IntraAgency Correspondence 7628 Homebound only - Immediate Needs
08 Inter/IntraAgency Correspondence 5809 Homeless Individual History Sheet
08 Inter/IntraAgency Correspondence 8183 HRA Incentive Bonus Documents
08 Inter/IntraAgency Correspondence 8672 HRA-107 Reinstatement of Split-Shift Home Care Services
08 Inter/IntraAgency Correspondence 5073 HS Systems Questionnaire 2 pages
08 Inter/IntraAgency Correspondence 0860 HSS Medical Information
08 Inter/IntraAgency Correspondence 5943 HSS Medical Referral Letter
08 Inter/IntraAgency Correspondence 1166 HSS Medical Results
08 Inter/IntraAgency Correspondence 1170 HSS Results of SN Appt
08 Inter/IntraAgency Correspondence 7091 HUD-52517 Request for Tenancy Approval
08 Inter/IntraAgency Correspondence 5074 Income Maintenance of Child's Placement/Discharge Notification to
08 Inter/IntraAgency Correspondence 6056 Inquiry Clearance
08 Inter/IntraAgency Correspondence 8431 IREA-123E MA Referral Closing
08 Inter/IntraAgency Correspondence 7410 JTP Client case notes letters notices forms
08 Inter/IntraAgency Correspondence 8067 Lab Results for BPSI
08 Inter/IntraAgency Correspondence 8223 LDSS-2425 Repayment of Interim Assistance Notice
08 Inter/IntraAgency Correspondence 8269 LDSS-2425A Repayment of Interim Assistance Notice
08 Inter/IntraAgency Correspondence 9031 LDSS-2726 Court Determination of Parentage
08 Inter/IntraAgency Correspondence 1214 LDSS-2921 Application for PA-MA-FS Benefits
08 Inter/IntraAgency Correspondence 8021 LDSS-2921A Emergency Assistance For Adults Applicant Statement
08 Inter/IntraAgency Correspondence 1218 LDSS-3174 Recertification for PA-MA-FS
08 Inter/IntraAgency Correspondence 5334 LDSS-3517 Turn Around Document TAD
08 Inter/IntraAgency Correspondence 8134 LDSS-4007 Notice of Decision of Initial Authorization
08 Inter/IntraAgency Correspondence 8199 LDSS-4007B HCPS Authorization No Aid
08 Inter/IntraAgency Correspondence 8135 LDSS-4008 Notice to Reduce or Discontinue Personal Care
08 Inter/IntraAgency Correspondence 8136 LDSS-4263 Notice to Authorize Response Services
08 Inter/IntraAgency Correspondence 8132 LDSS-4273 Notice to Discontinue Personal Care
08 Inter/IntraAgency Correspondence 8133 LDSS-4274 Notice to Increase or Decrease Personal Care
08 Inter/IntraAgency Correspondence 7846 LDSS-4529 Agreement to Repay Safety Net Assistance Still Owed
08 Inter/IntraAgency Correspondence 7230 LDSS-4647 Important Information about Child Care
08 Inter/IntraAgency Correspondence 7482 LDSS-4707 Intentional Program Violation IPV Ancillary Doc
08 Inter/IntraAgency Correspondence 7149 LDSS-4732-A DFR Cover Letter And Response Form
08 Inter/IntraAgency Correspondence 0856 Letter from Welfare Agency or Program
08 Inter/IntraAgency Correspondence 5077 Lift Sanction Letter
08 Inter/IntraAgency Correspondence 8715 LR-212 IREA Supplemental Needs Trust Request for Documentation
08 Inter/IntraAgency Correspondence 8513 LTC Fair Hearing Packet
08 Inter/IntraAgency Correspondence 6036 M-11a Home Care Services Program service request and authorization
08 Inter/IntraAgency Correspondence 8203 M-11K HC Final Notices
08 Inter/IntraAgency Correspondence 1616 M-11q Medical Request for Home Care
08 Inter/IntraAgency Correspondence 6804 M-15 Inq Regarding Vets' Benefits and Servicemen's Allotments
08 Inter/IntraAgency Correspondence 7073 M-183r Address Information Request
08 Inter/IntraAgency Correspondence 6024 M-186 Fair Hearing Documentation
08 Inter/IntraAgency Correspondence 6336 M-186 PA Fair Hearing Decision Tracking Sheet
08 Inter/IntraAgency Correspondence 6434 M-186a Conference Report
08 Inter/IntraAgency Correspondence 7694 M-186ce M-186ce Clinical Consultant Fair Hearing Review
08 Inter/IntraAgency Correspondence 1726 M-186dd Withdrawal of Fair Hearing Request
08 Inter/IntraAgency Correspondence 7286 M-186f Fair Hearing Representative Summary
08 Inter/IntraAgency Correspondence 6085 M-186F Notice of Fair Hearing Disposition
08 Inter/IntraAgency Correspondence 5085 M-186mm PA Fair Hearing Decision Tracking Sheet
08 Inter/IntraAgency Correspondence 6146 M-186PP Resolving Fair Hearing Issues
08 Inter/IntraAgency Correspondence 6032 M-186q Food Stamp Fair Hearing Decision Tracking Sheet
08 Inter/IntraAgency Correspondence 6020 M-186qq Relevant Case Folder or Evidence Packet Chcklst FH Summary
08 Inter/IntraAgency Correspondence 6739 M-186tt Mandatory Dispute Resolution - No Action Taken
08 Inter/IntraAgency Correspondence 6165 M-255A Transmittal of Active Cases transferred ATD's
08 Inter/IntraAgency Correspondence 1242 M-273 Motor Vehicle Questionnaire
08 Inter/IntraAgency Correspondence 1674 M-30P ICP IS-Job Center Match Follow-up Memo
08 Inter/IntraAgency Correspondence 5052 M-30x Case Action Worksheet
08 Inter/IntraAgency Correspondence 1490 M-31b Social Security Number Discrepancy on Closed Case
08 Inter/IntraAgency Correspondence 6152 M-31D Social Security Validation Report Worksheet
08 Inter/IntraAgency Correspondence 1486 M-31h Request for Correction of Information
08 Inter/IntraAgency Correspondence 1146 M-325A Statement of Lost Theft of Proceeds of PA Check
08 Inter/IntraAgency Correspondence 7400 M-325c Stop Payment Order
08 Inter/IntraAgency Correspondence 1206 M-325T Affidavit of Loss Theft Non-receipt of PA Check
08 Inter/IntraAgency Correspondence 5978 M-327 Case Update Questionnaire We are updating information PA-FS-MA
08 Inter/IntraAgency Correspondence 1740 M-327e Sixty Month Time Limit Checklist
08 Inter/IntraAgency Correspondence 8254 M-328d Notice of Completed Recoupment
08 Inter/IntraAgency Correspondence 8001 M-328l1 Timely Aid-Continuing Fair Hearing Language Insert
08 Inter/IntraAgency Correspondence 8002 M-328l2 Conference and Fair Hearing Information
08 Inter/IntraAgency Correspondence 6512 M-392A Case Review Record
08 Inter/IntraAgency Correspondence 1604 M-42f Referral Separate Determination of Medical Assistance
08 Inter/IntraAgency Correspondence 6741 M-42g Referral for Medicaid Eligibility Determination
08 Inter/IntraAgency Correspondence 1608 M-42n Transmittal to Medical Assistance Programs
08 Inter/IntraAgency Correspondence 6557 M-442 Referral Summary Form for Clients Moving Permanently Out of NYS
08 Inter/IntraAgency Correspondence 7283 M-442j Referral Summary Form For Clients Moving Out of NY State
08 Inter/IntraAgency Correspondence 7284 M-463 Application For Life Line Telephone Service
08 Inter/IntraAgency Correspondence 6532 M-58G Intake Clearance Form or Request for Case Record
08 Inter/IntraAgency Correspondence 1750 M-687m Safety Net Assistance Application Supplement
08 Inter/IntraAgency Correspondence 5093 M-687r Referral to Treatment Program
08 Inter/IntraAgency Correspondence 6786 M-74b Referral to Substance Abuse Service Center - SPV Assignment
08 Inter/IntraAgency Correspondence 6787 M-74d Employment Services Referral Form
08 Inter/IntraAgency Correspondence 6566 M-75c RTC Application Development Form
08 Inter/IntraAgency Correspondence 5950 M-75e Action Taken on your application PA-FS-MA
08 Inter/IntraAgency Correspondence 6809 M-75j Notification of CASAC Assessment Outcome
08 Inter/IntraAgency Correspondence 6811 M-75p Consent for Release of Info to Employment Vendor
08 Inter/IntraAgency Correspondence 6812 M-75w Consent for Release of Info from Treatment Program
08 Inter/IntraAgency Correspondence 6740 M-85 ORI/CMU Report of Bureau of Fraud Investigation Case Action Taken
08 Inter/IntraAgency Correspondence 6742 M-858m Utility Arrears or Emergency Heating
08 Inter/IntraAgency Correspondence 7626 M11-S-Homecare initial
08 Inter/IntraAgency Correspondence 7627 M11TR-Homecare Reauthorization
08 Inter/IntraAgency Correspondence 7625 M14P Homecare initial
08 Inter/IntraAgency Correspondence 7875 M20B Homemaker Service Report
08 Inter/IntraAgency Correspondence 7876 M20TR Authorization to Extend Homemaking Service
08 Inter/IntraAgency Correspondence 6355 MAP /E C507 SSI Unit-Request for Information
08 Inter/IntraAgency Correspondence 6357 MAP /E E316 Referral for Supplemental Security Income
08 Inter/IntraAgency Correspondence 6553 MAP 2052W DSS-486 Provider Refusal to Complete Form
08 Inter/IntraAgency Correspondence 6351 MAP 2055H Data Entry Error Correction Control Form
08 Inter/IntraAgency Correspondence 6521 MAP 2116 HED-Daily MES Case Submission Report
08 Inter/IntraAgency Correspondence 7138 MAP-2002D Referral For a Food Stamp Eligibility Determination
08 Inter/IntraAgency Correspondence 6258 MAP-2026D Transmittal to SSN Validation Liaison
08 Inter/IntraAgency Correspondence 6239 MAP-2043E Referral to Office of Legal Affairs (OLA)
08 Inter/IntraAgency Correspondence 5527 MAP-2088N Action Notice App Benefit For MA COBRA Premium Payment
08 Inter/IntraAgency Correspondence 5528 MAP-2088Q Notice App MA Pymnt Ins Prem Undr AIDS Hlth Ins Prgrm
08 Inter/IntraAgency Correspondence 6352 MAP-2100 Referral to ORI Real Property and Assets Section
08 Inter/IntraAgency Correspondence 5564 MAP-2109 Referral to Map Resource Unit
08 Inter/IntraAgency Correspondence 5532 MAP-2158D Notice to MA BuyIn Appl W Xcess Income MAP-258D replaces
08 Inter/IntraAgency Correspondence 5530 MAP-2158K Action Notice MA Premium Pymnt Prgrm MAP-258K replaces
08 Inter/IntraAgency Correspondence 8403 MAP-258P NYSDOH Income Report from SSA Records
08 Inter/IntraAgency Correspondence 7849 MAP-25F OED Case History Review Sheet
08 Inter/IntraAgency Correspondence 8283 MAP-25M CED Case History Review Sheet
08 Inter/IntraAgency Correspondence 8590 MAP-3001-cover/3002(E/S) Nursing Home Renewal
08 Inter/IntraAgency Correspondence 8313 MAP-3003 SSA CITIZENSHIP/IDENTITY MATCH 90-DAY NOTICE
08 Inter/IntraAgency Correspondence 8589 MAP-3036 Referral to Office of Legal Affairs
08 Inter/IntraAgency Correspondence 7932 MAP-316H Response to Request For Evidence Packet
08 Inter/IntraAgency Correspondence 6249 MAP/C P1345 Restricted Recipient Program Review Sheet
08 Inter/IntraAgency Correspondence 7852 Medical Bills for MKB Retroactive Relief Project
08 Inter/IntraAgency Correspondence 6591 Memorandum - Division for Youth EAF
08 Inter/IntraAgency Correspondence 6531 MEP-2159D Institutional Services Recertification Deferral Form
08 Inter/IntraAgency Correspondence 6072 Message from Social Security about your baby's social security card
08 Inter/IntraAgency Correspondence 0076 Methadone Program ID
08 Inter/IntraAgency Correspondence 8068 Miscellaneous Findings or Tests
08 Inter/IntraAgency Correspondence 7853 MKB Retroactive Relief Project Review Packet
08 Inter/IntraAgency Correspondence 7601 MKB-83J MKB Notice of Determination
08 Inter/IntraAgency Correspondence 7960 MKB-83Z MKB Notice of Non-Class Member Determination
08 Inter/IntraAgency Correspondence 0876 Notice of Eligibility Recommendation
08 Inter/IntraAgency Correspondence 8743 Notice of Intent to Reduce Public Assistance Public Shelter Resident
08 Inter/IntraAgency Correspondence 6101 Notice to Social Services
08 Inter/IntraAgency Correspondence 8073 NOWR
08 Inter/IntraAgency Correspondence 5082 NY State Dept of Labor Determination to Claimant Notice of
08 Inter/IntraAgency Correspondence 5083 NYC Dept of Probation Conditions of Probation Addendum
08 Inter/IntraAgency Correspondence 5084 NYS DSS AFIS Report of Match Results
08 Inter/IntraAgency Correspondence 6612 NYS OCFS IV-Emedicaid or EAF Appl
08 Inter/IntraAgency Correspondence 6608 NYS OCFS or Case Closing
08 Inter/IntraAgency Correspondence 6613 NYS OCFS or Notice of Eligibility
08 Inter/IntraAgency Correspondence 6610 NYS OCFS or Transmittal for VOA & 638J
08 Inter/IntraAgency Correspondence 6614 NYS OCFS Verification of Assistance Worksheet Federal Resources Unit
08 Inter/IntraAgency Correspondence 8676 NYS-Confirmation Letter for Human Trafficking Victim
08 Inter/IntraAgency Correspondence 8678 NYS-Minor Individual Referred As a Human Trafficking Victim
08 Inter/IntraAgency Correspondence 8677 NYS-Service Notice for Human Trafficking Victim
08 Inter/IntraAgency Correspondence 7908 OCA 960 Authorization To Release Health Information Pursuant To HIPAA
08 Inter/IntraAgency Correspondence 8854 OCFS-4915 History of Criminal Convictions and Parental Acknowledgment
08 Inter/IntraAgency Correspondence 8855 OCFS-4916 History of Day Care Enforcement and Parental Acknowledgment
08 Inter/IntraAgency Correspondence 8856 OCFS-4917 History of Termination of Parental Rights
08 Inter/IntraAgency Correspondence 8857 OCFS-LDSS-4699 Legally Exempt Family Child Care or in Home Child Care
08 Inter/IntraAgency Correspondence 8252 OCFS-LDSS-4699.2 Legally-Exempt In-Home Child Care Provider Agreement
08 Inter/IntraAgency Correspondence 0868 OCSE Results
08 Inter/IntraAgency Correspondence 7741 Office of Project Support Exhibit A
08 Inter/IntraAgency Correspondence 7742 Office of Project Support Exhibit B
08 Inter/IntraAgency Correspondence 7743 Office of Project Support Exhibit C
08 Inter/IntraAgency Correspondence 1048 ORI Referral Results
08 Inter/IntraAgency Correspondence 7041 ORI Referral to FIA Re Monetary Lawsuit Settlement
08 Inter/IntraAgency Correspondence 9020 Out of State Closing Requests
08 Inter/IntraAgency Correspondence 8071 Outreach Documents
08 Inter/IntraAgency Correspondence 6388 PCAP Recertification Notice
08 Inter/IntraAgency Correspondence 5086 Physician's Certification of Borrower's Total and Permanent Disability US DoE
08 Inter/IntraAgency Correspondence 8080 Physicians Functional Assessment Form
08 Inter/IntraAgency Correspondence 5087 Pre-Enrollment Agreement
08 Inter/IntraAgency Correspondence 5090 Pre-Fair Hearing Summary
08 Inter/IntraAgency Correspondence 6121 Presumptive Eligibility Application
08 Inter/IntraAgency Correspondence 6799 Project Cooperation Job Center Referral Form
08 Inter/IntraAgency Correspondence 8285 PRUCOL Documentation HASA
08 Inter/IntraAgency Correspondence 8089 Psychiatric Evaluations
08 Inter/IntraAgency Correspondence 1150 Recommendation from AOM
08 Inter/IntraAgency Correspondence 6724 Recoupment of Child Support Payments
08 Inter/IntraAgency Correspondence 7095 RED 17-1 Field Investigation Report-Center 17
08 Inter/IntraAgency Correspondence 7097 RED 17-3 RED Field Investigation Report-Shelter Case
08 Inter/IntraAgency Correspondence 7099 RED-25 Recertification Eligibility Division-Investigative Notes
08 Inter/IntraAgency Correspondence 0980 Referral from Family Court
08 Inter/IntraAgency Correspondence 0852 Referral from Shelter
08 Inter/IntraAgency Correspondence 6332 Referral Information
08 Inter/IntraAgency Correspondence 0972 Referral or Results from OES
08 Inter/IntraAgency Correspondence 6140 Request for Hearing by Administrative Law Judge
08 Inter/IntraAgency Correspondence 7619 Request for Service Line Eligibility Determination form-HASA
08 Inter/IntraAgency Correspondence 6565 Result of Conference with PA Recipient Contesting Rent Arrears Payment
08 Inter/IntraAgency Correspondence 5416 Returned Mail
08 Inter/IntraAgency Correspondence 8119 Rivera Certificate of Mailing
08 Inter/IntraAgency Correspondence 8343 RTSC Only-CASAC Packet
08 Inter/IntraAgency Correspondence 1174 SACC Results
08 Inter/IntraAgency Correspondence 8016 Scatter-site ll Case Assessment by HASA
08 Inter/IntraAgency Correspondence 8588 Service Line Application Packet
08 Inter/IntraAgency Correspondence 0984 SSA Referral
08 Inter/IntraAgency Correspondence 7794 SSA-003 Acknowledged Receipt of Hearing Request
08 Inter/IntraAgency Correspondence 5049 SSA-1696-U4 Appointment of Representative
08 Inter/IntraAgency Correspondence 5057 SSA-4268-C4 Explanation of Determination
08 Inter/IntraAgency Correspondence 5091 SSA-561-U2 Reconsideration Request for
08 Inter/IntraAgency Correspondence 5050 SSA-827 Authorization for Source to Release Information to SSA
08 Inter/IntraAgency Correspondence 7764 SSA-L8165 Explanation of Benefit Payment
08 Inter/IntraAgency Correspondence 6346 SSA-L8170 Overpayment Summary
08 Inter/IntraAgency Correspondence 6347 SSA-L928-U2 Social Security Notice of Reconsideration
08 Inter/IntraAgency Correspondence 7697 SSI Fair Hearing Packet
08 Inter/IntraAgency Correspondence 8065 SSI or SSDI Application
08 Inter/IntraAgency Correspondence 8066 SSI or SSDI Supporting Documentation
08 Inter/IntraAgency Correspondence 8520 State Online Query System (SOLQ) Referal)
08 Inter/IntraAgency Correspondence 0924 Statement from Agency or Program
08 Inter/IntraAgency Correspondence 5759 Structured History Sheet - Mail Recertification Project
08 Inter/IntraAgency Correspondence 8511 Substance Abuse Certificates of Completion
08 Inter/IntraAgency Correspondence 5753 Support Collections Unit Letter
08 Inter/IntraAgency Correspondence 6795 TEAP Participant Statement of Understanding
08 Inter/IntraAgency Correspondence 5096 TIU Change Referral
08 Inter/IntraAgency Correspondence 8214 Transitional Child Care Approval Documents-FOR TCC USE ONLY
08 Inter/IntraAgency Correspondence 8215 Transitional Child Care Disapproval Documents-FOR TCC USE ONLY
08 Inter/IntraAgency Correspondence 8969 Voluntary Assignment of Support Rights
08 Inter/IntraAgency Correspondence 8072 VRS Supporting Documentation
08 Inter/IntraAgency Correspondence 6348 W-10 Dependant Care Provider's Identification and Certification
08 Inter/IntraAgency Correspondence 6028 W-106 Follow up card
08 Inter/IntraAgency Correspondence 5990 W-112 Clearance Report on Applicant
08 Inter/IntraAgency Correspondence 5048 W-112C Application Control Card
08 Inter/IntraAgency Correspondence 1286 W-113E Information Referral Notice
08 Inter/IntraAgency Correspondence 5964 W-113M Appointment Notice and Documentation Guide
08 Inter/IntraAgency Correspondence 6211 W-123GG Food Stamp Photo ID Card Referral
08 Inter/IntraAgency Correspondence 6135 W-124H Report of Claim Determination
08 Inter/IntraAgency Correspondence 6209 W-129PP Food Stamp Eligibility Interview Appointment Notice
08 Inter/IntraAgency Correspondence 6433 W-129RR Important Notice Of Recertification Appointment Page 1
08 Inter/IntraAgency Correspondence 6210 W-132A Food Stamp Eligibility Determination History Sheet
08 Inter/IntraAgency Correspondence 1652 W-132DD Transmittal of IS-Job Center Food Stamp Case to NPA FS Center
08 Inter/IntraAgency Correspondence 1632 W-132K Referral To NPA Food Stamp Center
08 Inter/IntraAgency Correspondence 6632 W-134 Homebound Notice of Mail Certification Request for Documentation
08 Inter/IntraAgency Correspondence 6511 W-136 Case Rejection Audit
08 Inter/IntraAgency Correspondence 7148 W-137E Request to Pend an Application
08 Inter/IntraAgency Correspondence 1314 W-138V Eligibility Determination History
08 Inter/IntraAgency Correspondence 6360 W-140DD New Claim Calculation Worksheet
08 Inter/IntraAgency Correspondence 5899 W-140K Receptionist's Expedited Service Worksheet
08 Inter/IntraAgency Correspondence 6579 W-140M Discrepant Eligibility Information Tracking & Prescreening
08 Inter/IntraAgency Correspondence 8124 W-140WW Intensive Services Call In
08 Inter/IntraAgency Correspondence 1346 W-145F Recoupment Worksheet to Determine Hardship
08 Inter/IntraAgency Correspondence 7689 W-145G DHS or Shelter Facility Referral Form
08 Inter/IntraAgency Correspondence 6560 W-147A Replacement of Direct Vendor Payments
08 Inter/IntraAgency Correspondence 7699 W-147FF Claims and Collection Response
08 Inter/IntraAgency Correspondence 7147 W-147J NYCHA Commitment Form
08 Inter/IntraAgency Correspondence 5051 W-151L BCFI or FEDS Referral
08 Inter/IntraAgency Correspondence 1158 W-151N Citizenship NYC Referral
08 Inter/IntraAgency Correspondence 1854 W-153R Rental Assistance Unit Exception Policy
08 Inter/IntraAgency Correspondence 5851 W-154A CIS Referral
08 Inter/IntraAgency Correspondence 5999 W-164M Contact/Processing Summary
08 Inter/IntraAgency Correspondence 6362 W-180N CWA-Hospital Transfer Summary
08 Inter/IntraAgency Correspondence 8166 W-180R Fair Hearing-Conference Unit Referral for Eligibility Review
08 Inter/IntraAgency Correspondence 6976 W-186C Fair Hearing compliance statement
08 Inter/IntraAgency Correspondence 6569 W-186D Fair Hearing Compliance Request
08 Inter/IntraAgency Correspondence 8486 W-186E Fair Hearing Tracking Sheet
08 Inter/IntraAgency Correspondence 5056 W-2-188 Dept of Homeless Letterhead NYC
08 Inter/IntraAgency Correspondence 7569 W-200B Inter-Agency Date of Status or Date Entered Country Transmt
08 Inter/IntraAgency Correspondence 6363 W-203WW Data Entry Error Correction Transmittal
08 Inter/IntraAgency Correspondence 1730 W-204R Mandatory Dispute Resolution MDR Summary
08 Inter/IntraAgency Correspondence 6364 W-205S Selective Case Review Classification
08 Inter/IntraAgency Correspondence 6073 W-205T Case Review Alert
08 Inter/IntraAgency Correspondence 6037 W-208A Home Delivery Sheet of Public Assistance Checks
08 Inter/IntraAgency Correspondence 6718 W-209 Important Notice to Recipient About Child Support Bonus Payment
08 Inter/IntraAgency Correspondence 1402 W-25 History Sheet
08 Inter/IntraAgency Correspondence 1406 W-25D Request for Case Reopening
08 Inter/IntraAgency Correspondence 1570 W-25H Alien Status Review History Sheet
08 Inter/IntraAgency Correspondence 1522 W-270 Routing Control Sheet
08 Inter/IntraAgency Correspondence 5403 W-270A Routing Control Sheet
08 Inter/IntraAgency Correspondence 7566 W-274Z Referral Appointment Notice to from ACS Child Care Unit
08 Inter/IntraAgency Correspondence 7983 W-280N Locate Postal Clearance Letter
08 Inter/IntraAgency Correspondence 8168 W-280W Verified Employment of Non-Custodial Parent
08 Inter/IntraAgency Correspondence 8595 W-286K Professional License Payment Agreement Violation Notice
08 Inter/IntraAgency Correspondence 5158 W-293U Child/Teen Health Plan Informing & Offering Statement
08 Inter/IntraAgency Correspondence 6134 W-294D C-THP Reply Form (MAP-1096M E-S Replaces
08 Inter/IntraAgency Correspondence 6006 W-296P Documentation Guide for Recertification
08 Inter/IntraAgency Correspondence 6007 W-298 Documentation Guide for Recertification
08 Inter/IntraAgency Correspondence 7800 W-299 Notice to Applicants Regarding Third Party Health Insurance
08 Inter/IntraAgency Correspondence 6977 W-299A Request for payments of Third Party Health Insurance
08 Inter/IntraAgency Correspondence 6558 W-30M Rejection Summary
08 Inter/IntraAgency Correspondence 6589 W-30P Memorandum - Case being referred to ISC for follow-up action
08 Inter/IntraAgency Correspondence 5977 W-30V Case Closing
08 Inter/IntraAgency Correspondence 6164 W-30Z Transfer to Summary
08 Inter/IntraAgency Correspondence 7977 W-333N DSP Mandatory Assessment Call in for Seniors
08 Inter/IntraAgency Correspondence 1530 W-34A Referral Information Form
08 Inter/IntraAgency Correspondence 1612 W-34A Referral Information Form
08 Inter/IntraAgency Correspondence 5993 W-393B Client Treatment Program Information
08 Inter/IntraAgency Correspondence 6524 W-395 HRA Medical History and Examination
08 Inter/IntraAgency Correspondence 5078 W-4 Memorandum
08 Inter/IntraAgency Correspondence 5079 W-4-500M Memorandum
08 Inter/IntraAgency Correspondence 5972 W-401A BFI DFRP FO Referral X1103
08 Inter/IntraAgency Correspondence 6370 W-442X Meal Preparation Assessment Form
08 Inter/IntraAgency Correspondence 7326 W-448GG Initial Client Information Sheet
08 Inter/IntraAgency Correspondence 6038 W-450A Homelessness Diversion Intake Tracking Sheet
08 Inter/IntraAgency Correspondence 6559 W-450D Rent Arrears Alert Data Entry Form
08 Inter/IntraAgency Correspondence 6181 W-450e HDU Referral to Community Based Organization on Form
08 Inter/IntraAgency Correspondence 6112 W-453 Outcome report from job pathway center to income support center
08 Inter/IntraAgency Correspondence 0892 W-456AA SACC Referral Letter
08 Inter/IntraAgency Correspondence 7327 W-488H HASA Case Problem/Action Form
08 Inter/IntraAgency Correspondence 7653 W-488K Case Transfer Summary
08 Inter/IntraAgency Correspondence 7648 W-488N Sub-Impress Authorization Form
08 Inter/IntraAgency Correspondence 7666 W-488Q Primary Tenant Statement Re Occupancy of Second Tenant
08 Inter/IntraAgency Correspondence 6245 W-488X Request for Program Admission
08 Inter/IntraAgency Correspondence 7647 W-488Y Field Visit Itinerary
08 Inter/IntraAgency Correspondence 7656 W-490M HASA Client appeal process
08 Inter/IntraAgency Correspondence 5080 W-5 Memorandum
08 Inter/IntraAgency Correspondence 8160 W-500ZZ Training Documentation Return Appointment
08 Inter/IntraAgency Correspondence 8197 W-502E CUNY Jobs Plus Program Assignment Letter
08 Inter/IntraAgency Correspondence 1534 W-515 General Release
08 Inter/IntraAgency Correspondence 5145 W-515J Certification/Recertification Checklist
08 Inter/IntraAgency Correspondence 5399 W-515N Referral to Citizenship-NYC
08 Inter/IntraAgency Correspondence 6870 W-515X Systematic Alien Verification for Entitlements
08 Inter/IntraAgency Correspondence 6147 W-518 Resource Analysis and Plan of Action
08 Inter/IntraAgency Correspondence 5065 W-519 Finger Imaging Notice
08 Inter/IntraAgency Correspondence 8146 W-519C Finger Imaging Report Routing Slip
08 Inter/IntraAgency Correspondence 8221 W-519N Finger Image Requirements for Food Stamp Clients
08 Inter/IntraAgency Correspondence 8222 W-519P Finger Imaging Centers for Food Stamp Clients
08 Inter/IntraAgency Correspondence 6098 W-523A Notice to Applicant Referral for Elig Verification Review
08 Inter/IntraAgency Correspondence 8231 W-523R Applicant Referral to Bureau of Eligibility Verification
08 Inter/IntraAgency Correspondence 1538 W-525 Referral for Fraud Investigation Refund Summary
08 Inter/IntraAgency Correspondence 6129 W-525W Referral for Eligibility Verification
08 Inter/IntraAgency Correspondence 6373 W-532A Referral for Eligibility Verification Review
08 Inter/IntraAgency Correspondence 0976 W-532R Notice to ApplicantReferral for Eligibility Verification
08 Inter/IntraAgency Correspondence 6100 W-532UU Notice to Report for Public Assistance Eligibility Review
08 Inter/IntraAgency Correspondence 1640 W-532X Daily Record of I Interviews
08 Inter/IntraAgency Correspondence 6441 W-532Z Notice to Client Referral for Eligibility Review
08 Inter/IntraAgency Correspondence 6537 W-534C New Application Questionnaire
08 Inter/IntraAgency Correspondence 6374 W-538 Physician's Functional Assessment Form
08 Inter/IntraAgency Correspondence 5076 W-573M Language Program Referral Letter
08 Inter/IntraAgency Correspondence 7036 W-585A Settlement Form - Report of Action Taken
08 Inter/IntraAgency Correspondence 6014 W-586D Elig Verification Review Report of Eligibility Recommendation
08 Inter/IntraAgency Correspondence 6203 W-586N BEV/Medicaid Interview Check off Sheet
08 Inter/IntraAgency Correspondence 7108 W-587E Undercare field data entry form or recommendation screen
08 Inter/IntraAgency Correspondence 6519 W-587P BEV Interview and Field Investigation Report
08 Inter/IntraAgency Correspondence 6012 W-588B Eligibility Verification Review Home Visit
08 Inter/IntraAgency Correspondence 7183 W-590C BEV Phone Bank Alert Notice Of Rescheduled Home Appoint
08 Inter/IntraAgency Correspondence 6672 W-590H Child Information Attestation Document RED-6a
08 Inter/IntraAgency Correspondence 6673 W-590J Financial Information Attestation Document RED 7-a
08 Inter/IntraAgency Correspondence 8274 W-590UU IREA Liens and Recovery Infant Lien Amount letter
08 Inter/IntraAgency Correspondence 8275 W-590VV IREA Liens and Recovery Insurance Company Claim letter
08 Inter/IntraAgency Correspondence 8276 W-590WW IREA Liens and Recovery Lien Amount letter
08 Inter/IntraAgency Correspondence 8277 W-590XX IREA Liens and Recovery Non-Assert letter
08 Inter/IntraAgency Correspondence 8278 W-590YY IREA Liens and Recovery Notice Of Lien
08 Inter/IntraAgency Correspondence 8279 W-590YY_1 IREA Liens and Recovery Notice Of Lien (amended)
08 Inter/IntraAgency Correspondence 7034 W-592K Division of Financial Review and Processing Worksheet
08 Inter/IntraAgency Correspondence 8232 W-593Y Applicant Referral to Bureau of Eligibility Verification - HV
08 Inter/IntraAgency Correspondence 6141 W-607A Request Identification card temporary Medicaid authorization
08 Inter/IntraAgency Correspondence 6378 W-607T Request for Common Benefit Identification Card
08 Inter/IntraAgency Correspondence 5979 W-608VV CBIC - Common Benefit ID Card Letter referring to
08 Inter/IntraAgency Correspondence 5984 W-62 Checklist for Case Transfer
08 Inter/IntraAgency Correspondence 6379 W-650A ACD Request for Cash Grant IVA Day Care Approval-Employ
08 Inter/IntraAgency Correspondence 6572 W-650C UCR Face Sheet and Request or Notification Authorization Form
08 Inter/IntraAgency Correspondence 1542 W-674A Record of Special Grant Cancellation & Duplication
08 Inter/IntraAgency Correspondence 1008 W-680 Out of NYC Birth or Death Verification Request
08 Inter/IntraAgency Correspondence 1628 W-680B Application-Job Profile
08 Inter/IntraAgency Correspondence 1668 W-680E Job Center Tracking System
08 Inter/IntraAgency Correspondence 1664 W-680F Applicant's Task List
08 Inter/IntraAgency Correspondence 1660 W-680H Employment Plan 35-50 Days to Employment
08 Inter/IntraAgency Correspondence 6431 W-680N DOL Referral Form
08 Inter/IntraAgency Correspondence 6437 W-680V Case Management Participation Profile
08 Inter/IntraAgency Correspondence 6119 W-680W Participant's Task List
08 Inter/IntraAgency Correspondence 1012 W-681 Out of NYC Marriage or Divorce Verification Request
08 Inter/IntraAgency Correspondence 1546 W-701 Request for Birth or Death Verification-NYC Dept Health
08 Inter/IntraAgency Correspondence 1550 W-701A Request for Certified Copy Of Birth or Death Certificate
08 Inter/IntraAgency Correspondence 6167 W-710-1 Unit Daily Record of Action Taken
08 Inter/IntraAgency Correspondence 7175 W-779A CWA Notice to OCSE Of Foster Child's Placement or Discharge
08 Inter/IntraAgency Correspondence 8264 W-820E Income Savings Requirement
08 Inter/IntraAgency Correspondence 8280 W-820F Income Savings Requirement (DHS Insert)
08 Inter/IntraAgency Correspondence 8281 W-820H Income Savings Requirement (ODVEIS Insert)
08 Inter/IntraAgency Correspondence 8282 W-820l Income Saving Requirement (HPD Insert)
08 Inter/IntraAgency Correspondence 7654 W-897B Client Rights or Respons or as Emergency Facility Resident
08 Inter/IntraAgency Correspondence 7660 W-897E Notice of Withdrawal of or App or for Program Admission
08 Inter/IntraAgency Correspondence 7006 W-897Q Rental Assistance Form 2 Excess Rent Maint. Of Residence
08 Inter/IntraAgency Correspondence 7646 W-897R Work Opp & Transitional Benefits/Income Disregard
08 Inter/IntraAgency Correspondence 7661 W-897U Case reassignment Letter
08 Inter/IntraAgency Correspondence 7655 W-897V Client satisfaction questionnaire EPU
08 Inter/IntraAgency Correspondence 7643 W-899E HASA Housing services-Statement of Non-participation
08 Inter/IntraAgency Correspondence 7644 W-899F HASA Services/Benefits-Statement of Non-participation
08 Inter/IntraAgency Correspondence 7659 W-899M Referral to OHMHS for Psychiatric Evaluation
08 Inter/IntraAgency Correspondence 7873 W-900A Verification of Homemaker Services Overtime Hours
08 Inter/IntraAgency Correspondence 7872 W-900P List of Homemaker tasks
08 Inter/IntraAgency Correspondence 7874 W-900T Application for Homemaking Services
08 Inter/IntraAgency Correspondence 8006 W-902G Request for Certified Copy of Birth Certificate
08 Inter/IntraAgency Correspondence 8005 W-902K HASA Referral to CASAC Form
08 Inter/IntraAgency Correspondence 8284 W-902T-Referral to FEC for Managed Care Form 9-28-10
08 Inter/IntraAgency Correspondence 8325 W-902V Notice of Intent to Reduce or Terminate Homemaker Services
08 Inter/IntraAgency Correspondence 8801 W-902V-a Notice of Decision Regarding Personal Care/Homemaking Services
08 Inter/IntraAgency Correspondence 6540 W-904D Notice of Claimant Enrollment from Income Maintenance Depart
08 Inter/IntraAgency Correspondence 6011 W-904E Eligibility Status of Addict or Alcoholic
08 Inter/IntraAgency Correspondence 7796 W-904E Eligibility Status of an individual with Substance Abuse
08 Inter/IntraAgency Correspondence 6148 W-904H RTC Residence Report
08 Inter/IntraAgency Correspondence 6382 W-906B Request for Third Party Health Insurance Information
08 Inter/IntraAgency Correspondence 6383 W-907HH Landlord Clearance
08 Inter/IntraAgency Correspondence 6384 W-907T Result of Enhance Quality Assurance Case Review
08 Inter/IntraAgency Correspondence 6385 W-908B Recertification Batch Data Entry Transmittal
08 Inter/IntraAgency Correspondence 6060 W-909 Interview Worksheet for Recertification
08 Inter/IntraAgency Correspondence 1470 W-909FF Recertification History Sheet
08 Inter/IntraAgency Correspondence 1526 W-909R W-272G Authorization to Cancel Scheduled Appointment
08 Inter/IntraAgency Correspondence 6023 W-909YY Face to Face Recertification Guide for required documentation
08 Inter/IntraAgency Correspondence 6263 W-912GG Audit of QRS Clerk
08 Inter/IntraAgency Correspondence 1474 W-912H Earned Income Monthly Report
08 Inter/IntraAgency Correspondence 6136 W-913 Request for Case Closing
08 Inter/IntraAgency Correspondence 6508 W-932 Baseline Clinical and Employability Assessment
08 Inter/IntraAgency Correspondence 6387 W-932A Alcoholism-Substance Abuse Treatment Prgrm Progress Rpt
08 Inter/IntraAgency Correspondence 6366 W2-112 Request for Reimbursement of Expenses to Attend Fair Hearing
08 Inter/IntraAgency Correspondence 7630 W34A CBCFA-Moving Expense - CBCFA
08 Inter/IntraAgency Correspondence 7621 W34A Itemized-Furniture Grant-CBCFA
08 Inter/IntraAgency Correspondence 6444 W904JJ Designation of FS Status of Foster Child
08 Inter/IntraAgency Correspondence 8090 WeCare Fair Hearing packet
08 Inter/IntraAgency Correspondence 8078 Wellness Plan Completed
08 Inter/IntraAgency Correspondence 8077 Wellness Plan Initiated
08 Inter/IntraAgency Correspondence 8079 Wellness Plan Supportive Documentation
08 Inter/IntraAgency Correspondence 8060 Wellness Rehabilitation Plan
09 Match Information 6599 26 Memorandum - Match Material for Filing In Case Record
09 Match Information 6596 36 Memorandum - ICP Recoupment or Overpayment Claim Calculation
09 Match Information 6600 61 Memorandum - Match Material for Filing in case Record
09 Match Information 6595 67 Memorandum - ICP Match on A Closed or Stopped Individual of Case
09 Match Information 8188 AUTO REDUCTION MATCH FORM BNX027W2
09 Match Information 7580 BNX 220R3 PA Bendex Error Out Match
09 Match Information 6587 FCM210-R1 Match by other than childs name
09 Match Information 6582 Foster Care - IM Child Match ICP
09 Match Information 7596 HHC045R1 ICP- Health and Hospital Corporation Match Source Document
09 Match Information 6620 HHC045R1 Report ICP Index - HHC Match
09 Match Information 7982 HHCO45R1-Health and Hospitals Wage Match
09 Match Information 6590 ICP 78 Memorandum - Computer Match Packets From
09 Match Information 6585 JTP VS PA Match Records JTP665-R1
09 Match Information 6048 M-3 Income Clearance Program Marriage Bureau Computer Match Worksheet
09 Match Information 6601 Memorandum - Match Material for ISC Review & Appropriate Action
09 Match Information 6604 NYC County Dept. of SS - Lottery Intercept Report
09 Match Information 8248 PASDX Social Security Cintrax
09 Match Information 6623 State Insurance Fund Match
09 Match Information 6577 UIM371 Death Match-PA Health Dept Deceased Name Address Discrepancy
09 Match Information 7180 UIM420-R1 PA/Correction Dept. Match
09 Match Information 8296 UIM520- R1 = DEATH MATCH (NPA) WORKSHEET
09 Match Information 6622 UIM915 State Insurance Fund Disability Benefits File
09 Match Information 6667 W-138RR NPA Computer Match Worksheet or Closed Cases
09 Match Information 6645 W-140KK Computer Match Unit DFRP Notification to IS or Job Centers
09 Match Information 6586 W-25 Lottery Lump Sum History Sheet
09 Match Information 6375 W-585F The City of NY HRA Elig Verification Review Program Undercare
09 Match Information 7182 W-588H DFRP BFI Case Action Taken
09 Match Information 7579 WINRO 742 PA Bendex Recoupment Only Match