IM-41 FILLABLE PDF VERSIONS OF PRESUMPTIVE ELIGIBILITY (PE) FORMS

Department of Social Services
Family Support Division
PO Box 2320
Jefferson City, Missouri

TO:  ALL FAMILY SUPPORT OFFICES

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  FILLABLE PDF VERSIONS OF PRESUMPTIVE ELIGIBILITY (PE) FORMS

FORM REVISION #10  

PE-2 Worksheet
PE-3
PE-3 TEMP

DISCUSSION:

The purpose of this memo is to introduce fillable PDF versions of the:

• Qualified Entity Presumptive Eligibility Determination Worksheet (PE-2 Worksheet);
• MO HealthNet Presumptive Eligibility Authorization (PE-3); and
• MO HealthNet TEMP/SMHB-PE Authorization (PE-3 TEMP)

These three forms, along with the previously released Application for Presumptive Eligibility (PE-1SSL) will be made available to all Qualified Entities.

 

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

 

KE/df