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 1049 Verification of Vital Event  Receipt of Application for SSN  Application Checklist

Medicaid-only Cases (Notices and Forms Should Be Filed Accordingly)

Section One  Generic or D.C. Healthy Families Application  1052 Record of Case Action  CAD Addendum  Generic Recertification  Checklist  1209 Recertification Form  1288/a Notice to IV-D  Presumptive Eligibility Form(s)  1673A Third Party Liability Form  495 Authorization for Investigation  1400 Notice to Applicant  1673B Notice of Potential Medicaid Payment Recovery

|Section Two  Recertification Packet o Disposition Notice o Interface Printout(s) o Income Verification o Asset Verification