Department of Social Services
Family Support Division
PO Box 2320
Jefferson City, Missouri
TO: ALL FAMILY SUPPORT OFFICES
FROM: PATRICK LUEBBERING, DIRECTOR
SUBJECT: REVISED MO HEALTHNET REVIEW INFORMATION FORM (FA402)
FORM REVISION #15 – FA-402
The FA402 generated by FAMIS and the paper version have been updated to include questions and declaration statements related to the changes made due to House Bill 2171, as described in IM-58 dated Sept. 28, 2018.
Questions added include:
- Do any household members, who are receiving Blind Pension benefits, have a valid driver license in any state or U.S. Territory? Date of issue:
- Has any household member operated a motor vehicle while receiving Blind Pension? Who: Date:
Declaration statements added:
- I/we understand that if I/we obtain or renew a driver license while receiving Blind Pension benefits I/we will be sanctioned from the Blind Pension program for 2 years, 4 years, or permanently.
- I/we understand that if I/we operate a motor vehicle while receiving Blind Pension benefits I/we will be sanctioned from the Blind Pension program for 2 years, 4 years, or permanently.
The new FA402 has a revision date of 8/18.
- Review this memorandum with appropriate staff.