Page 6

BAM 300 6 of 14 THE CASE RECORD BPB 2026-016 7-1-2026

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

DHS-13, Supplemental Payment Authorization.

HDS-521, Notification of Restoration Letter.

DHS-1172s, FIP/SDA Worksheet or LOA2 Worksheet, showing the under-issuance.

DHS-3925, Restoration of Lost Food Assistance Benefit, or LOA2 OI/UI summary.

Plain paper with the under-issuance calculation, if needed.

Correspondence and other documents related to the supplementation. At the local office option, under-issuance materials may be placed I the obsolete packet after the client supplement is issued. ECF The ECF does not contain an eligibility packet/tab. Documents are stored under the appropriate tab. Vital Statistics Packet Paper, ECF Use this packet for documents expected never to (or only infre- quently) change, even after closures and reopenings. Include the following for each group member unless an item is more useful in the eligibility packet: • Adoption records. • Alien registration card. • Birth certificate. • Death certificate. • Divorce decree. • Driver's license or other ID card. • Social Security card. • DHS-8A, Irrevocable Funeral Contract Certification. • Marriage certificate. • Naturalization records. • Passport. • Paternity records. • Power of attorney/guardianship papers. • Prepaid funeral contract.

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Page 6

Official source

BAM 300 6 of 14 THE CASE RECORD BPB 2026-016 7-1-2026

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

DHS-13, Supplemental Payment Authorization.

HDS-521, Notification of Restoration Letter.

DHS-1172s, FIP/SDA Worksheet or LOA2 Worksheet, showing the under-issuance.

DHS-3925, Restoration of Lost Food Assistance Benefit, or LOA2 OI/UI summary.

Plain paper with the under-issuance calculation, if needed.

Correspondence and other documents related to the supplementation. At the local office option, under-issuance materials may be placed I the obsolete packet after the client supplement is issued. ECF The ECF does not contain an eligibility packet/tab. Documents are stored under the appropriate tab. Vital Statistics Packet Paper, ECF Use this packet for documents expected never to (or only infre- quently) change, even after closures and reopenings. Include the following for each group member unless an item is more useful in the eligibility packet: • Adoption records. • Alien registration card. • Birth certificate. • Death certificate. • Divorce decree. • Driver's license or other ID card. • Social Security card. • DHS-8A, Irrevocable Funeral Contract Certification. • Marriage certificate. • Naturalization records. • Passport. • Paternity records. • Power of attorney/guardianship papers. • Prepaid funeral contract.