C.M.R. 10, 144, ch. 311, VI

Current through 2024-51, December 18, 2024

Chapter VI - APPENDIX

Note: For paper copies of these forms, contact the Department. Some could not be converted into electronic format for this version of Chapter 311.

Forms - Definitions

1. SWWN-002: Bill for Child Care Services

2. SWWN-026: WIN Registration Referral

3. SWWN-029: Notice to WIN/ES of AFDC Change

4. SWSS-083: Social Service Face Sheet

5. SWSS-085: Social Service Program Sheet

6. SWIM-017: Medical Statement Signed by Physician

7. G-16A: Purchase Authorization

8. G-31: Departmental Bill Head

9. ES-571-A: Waiver for Release of Information

10. ES-571-B: Employment Capacities Report Physical Status

11. ES-571-C: Employment Capacities Report Mental Status

12. MA-49: Request for Payment of Professional Services

13. MA 5-95: WIN Registration Record

14. MA 5-96: WIN Certification Record

15. MA 5-97: WIN Status Change Notice

16. SRS-NCSS-117, Part A: WIN Certifications Report

17. SRS-NCSS-117, Part B: AFDC WIN Grant Reductions Report

C.M.R. 10, 144, ch. 311, VI