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Notice of Privacy Practices (If Applicable)

1400 Notice to Applicants

Third Party Liability Form (If Applicable)

1052 Record of Case Action

Checklist to Be Given to Applicant/recipient

Voter Registration (If Applicable)

Presumptive Eligibility Form(s) (If Applicable)

V- 2: Information to Collect from Applicant:

Residency Verification

Income Verification

Asset Verification

Relationship Verification (If Applicable)

Age Verification (If Needed)

Confirmation of Pregnancy (If Applicable)

Confirmation of Disability from SSA (If Applicable)

V- 3: Actions to Be Taken:

Explain EPSDT (If Applicable)

Check Interface Screen Before Terminating Interview

Discuss Child Support Requirement and Sanction (If Applicable