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1693 Spend-down Worksheet - form used to compute periods of Medicaid eligibility under spend- down provisions. Original in record.

1747 Food Stamp Claims Report - forms used to report FS overpayment. Original plus one copy along with verification is sent to FS Special Services Unit. Copy kept in case record 1779 Referral for Photo ID - form used to refer those FS applicants/recipients who have no official form of identification. 1926 Citizenship/Alienage Declaration - addendum used at application to ascertain citizenship and/or immigration status. When adding a person to the assistance unit, use a new addendum. 1934 Notice of Presumptive Eligibility Determination - form completed by agency to notify applicant/recipients of eligibility for presumptive eligibility for ambulatory prenatal care. Original to customer, copy in record. 1935 Presumptive Eligibility Determination Form - form completed by customer to determine eligibility for presumptive eligibility prenatal services. Original in record.