Department of Social Services
Family Support Division
PO Box 2320
Jefferson City, Missouri
TO: ALL FAMILY SUPPORT OFFICES
FROM: KIM EVANS, DIRECTOR
SUBJECT: FAMILY SUPPORT DIVISION (FSD) DOCUMENTS UPDATED TO USE CENTRALIZED ADDRESS AND FAX
DISCUSSION:
FSD is moving to a centralized mail process beginning in January 2023.
Updates include having participants submit most mail to a single mailing address and/or fax number. Participants can send applications, reviews, or other information to:
- Mail: Family Support Division, PO BOX 2700, Jefferson City, MO 65102
- Fax: 573-526-9400
The mailing address and fax number are being updated online and in FSD eligibility systems over the next few weeks. System generated forms and notices will display the updated address as the return address.
Many FSD forms and documents were revised and have a 1/2023 revision date.
Revised forms available in the public forms manual:
| Form Number | Form Name |
| FA-402 | MO HealthNet Eligibility Review Information |
| FA-402 (Spanish) | Informacion Sobre la Revision de la Elegibilidad para Acceder a MO HealthNet |
| IM-1ABDS | Aged, Blind, and Disabled Supplement |
| IM-1ABDS (Spanish) | Anexo Personas Mayores, Invidentes y Discapacitadas |
| IM-1ABDS (Large Print) | Aged, Blind, and Disabled Supplement (Large Print) |
| IM-1MSP | Application for Medicare Savings Programs |
| IM-1MSP (Spanish) | Solicitud para Programas de Ahorros de Medicare |
| IM-1MSP (Large Print) | Application for Medicare Savings Programs (Large Print) |
| IM-1SSL | Application for Health Coverage and Help Paying Costs |
| IM-1SSL (Spanish) | Solicitud de Cobertura Medica y Ayuda para el Pago de Costos |
| IM-1SSL (Dari) | درخواست برای پوشش بهداشت و کمک هزینه های پرداخت |
| IM-1SSL (Pashto) | روغتیا پوښښ لپاره غوښتنلیک او د لګښتونو تادیه کې مرسته |
| IM-1SSL Ongoing | Ongoing Coverage Signature Request for Household Members |
| IM-1TA | Application for Temporary Assistance Cash Benefits |
| IM-1TA (Spanish) | Solicitud de Beneficios de Dinero en Efectivo de Asistencia Temporal |
| IM-1TA (Dari) | درخواست کمک های موقت کمک های نقدی |
| IM-1TA (Pashto) | د لنډمهاله مرستې نغدو ګټو لپاره غوښتنلیک |
| IM-1U | MO HealthNet Eligibility Review Form |
| IM-2SR | Signature Request Form |
| IM-2SR (Spanish) | Solicitud de Firma |
Revised forms available to FSD staff in the internal forms manual:
| Form Number | Form Name |
| IM-1REQ | Application Request |
| IM-1U90 | Review Received Outside Reconsideration Period |
| IM-40 | Citizen/National/Eligible Immigrant Attestation |
| PE-1SSL | Application for Presumptive Eligibility |
| PE-2 Worksheet | Qualified Entity Presumptive Eligibility Determination Worksheet |
| PE-3 | MO HealthNet Presumptive Eligibility Authorization |
| PE-3PW | MO HealthNet TEMP/SMHB Authorization |
NECESSARY ACTION:
- Review this memorandum with appropriate staff.
- Begin using revised forms immediately.
- Share with community partners.
KE/cj