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1. Excess Resources 2. Unreported Income VA Unreported 3. Special Needs Trust 4. Conditional Assistance All of the other payments listed on the form are mailed to: DPHHS/ FISCAL; PO BOX 4210; HELENA, MT 59604. If you have Public Assistance Bureau questions or concerns, contact the individual program policy specialist. Examples of other payments include: 1. Food Stamp Allotment Repayment (Cash not accepted) 2. Cash Assistance Repayment 3. Interim Assistance Reimbursement (SSI) 4. TANF Benefits 5. Other TANF Supportive Service The fourth part of the form (gold) is retained at the Office of Public Assistance and attached to the log. Review log to identify and follow up on all missing yellow receipts from the Fiscal Bureau, TPL Unit, and/or CSED. If you have questions, contact Fiscal Bureau Accounts Receivable for help. Once the Fiscal Bureau, CSED, or TPL Unit signs and dates their copies, they will detach the bottom (yellow) copy to send back to the OPA. The OPA then enters the date returned on the log and files the (yellow) copy in the recipient's case file as proof of deposit. Effective Date: April 01, 2010