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BAM 105 2 of 20 RIGHTS AND RESPONSIBILITIES BPB 2026-016 7-1-2026

BRIDGES ADMINISTRATIVE MANUAL STATE OF MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES

Exception: FIP, SDA, RCA and FAP If an application is received by the local office for cash or FAP but is not signed by the client, the client should be contacted by phone to obtain the verbal signature. If a verbal signature cannot be obtained, the application should be returned to the client along with a DHS-330, Notice of Missing Information, informing the client of the missing information. Note: If an applicant applies for multiple programs which include FAP and/or CDC and the birthday of the applicant is missing, the FAP and/or CDC programs must be registered. Do not return an application for health care coverage to an applicant; see BAM 115, Application Processing for when to use the DHS-330, Notice of Missing Information. A MDHHS-1171, filing form is not acceptable for any category of health care coverage. Family Independence Program (FIP), State Disability Assistance (SDA), Refugee Cash Assistance (RCA) and Refugee Medical Assistance (RMA) Treat a faxed or emailed application or filing form as an incomplete application. The Michigan Department of Health and Human Services (MDHHS) must receive an original signature before benefits are approved. See Right to Apply in the Client Rights section of this item. FAP A photocopy, facsimile (fax) or an Internet version of a MDHHS- 1171, Assistance Application, or the filing form is acceptable. An original signature is not required. Medicaid (MA) A photocopy, facsimile (fax) or an electronic version of a DCH- 1426, DHS-3243, MDHHS-1171, and DHS-4574 is acceptable. The federal application for health coverage is acceptable for any Medicaid category. Additional information may be required for an SSI-related category. An original signature is not required.