Department of Social Services
Family Support Division
PO Box 2320
Jefferson City, Missouri
TO: ALL FAMILY SUPPORT OFFICES
FROM: PATRICK LUEBBERING, DIRECTOR
SUBJECT: SIGNATURE REQUEST LETTER UPDATED FOR MO HEALTHNET APPLICATIONS AND REVIEWS
FORM REVISION #13
The Signature request letter has been updated so that it can be used with unsigned applications or unsigned reviews received for MO HealthNet for the Aged, Blind, and Disabled or MAGI Programs. This form can be located alphabetically in the Forms Manual. Discontinue using the IM-1SSL Signature Request Letter.
Application or Review for Closed Case
If the returned form is an application or a review for a case that closed less than 90 days ago, check the top box in the lower shaded section. Return the original form with the Signature Request Letter and an FSD addressed envelope to the participant within three business days.
Review Case Closed over 90 Days
If the returned form is an unsigned FA-402 for a case that closed more than 90 days ago, send the FA-402 Letter. If the returned form is an unsigned IM-1U, send the IM-1Us Returned After 90 Days Letter.
Review for an Open Case
If the returned form is an unsigned review for a case that has not closed , check the bottom box. Enter the last date the case will be open if the signed form is not returned. Send the original unsigned application or review with the Signature Request Letter and an FSD addressed envelope to the participant within three business days.
- Review this memorandum with appropriate staff.