IM-31 APRIL 2023 – QUARTERLY FORMS UPDATE

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

TO:  ALL FAMILY SUPPORT OFFICES

FROM: KIM EVANS, DIRECTOR

SUBJECT: APRIL 2023 – QUARTERLY FORMS UPDATE

 

DISCUSSION:

Income Maintenance forms and documents are reviewed and revised quarterly and as necessary. New forms and documents are created as required or requested.

All new and revised forms show a revision date of 4/2023. Revised forms with older revision dates are now obsolete. Family Support Division (FSD) will accept obsolete forms until 6/30/2023.

 

New and Revised Forms available in the public and internal forms manuals:

Form Number Form Name New or Revision:
CARS-8 Request for Reduction of Claim Revised to update terminology and remove unnecessary fields.
CARS-8 Instructions Instructions for Request for Reduction of Claim Revised to update terminology and remove unnecessary fields.
IM-1MAC

Addendum to MO HealthNet Application: Request for optional cash benefits

Revision to allow electronic signatures. New PDF format.
IM-1MAC (Spanish) Complemento de la Solicitud de MO HealthNet: Solicitud de Beneficios Opcionales en Dinero en Efectivo Revision to allow electronic signatures.

IM-6AR

IM-6AR (Large Print)

Appointing an Authorized Representative Revision to change MO HealthNet (MHN) terminology to annual renewal.
IM-6AR (Spanish) Designacion de un Representante Autorizado Revision to change MHN terminology to annual renewal.
IM-31F Applying for SNAP Benefits Revision to clarify that Residency verification is only required when questionable.
IM-31F (Spanish) Solicite beneficios del SNAP Revision to clarify that Residency verification is only required when questionable.
IM-110 Statement of Loss/Replacement Request Revision to use central mail address.

 

New and Revised Forms available only to FSD staff in the internal forms manual:

Form Number  Form Name New or Revision:
FSD/SMH Cover MO HealthNet Application for DMH Consumers in a State Mental Hospital Form was revised by DMH to provide updated application processes and information for DMH staff. This form has a revision date of 9/2022.
IM-1U90 Annual Renewal Received Outside Reconsideration Period Revision to change form name and MHN terminology to annual renewal.

 

Obsolete forms should no longer be used by FSD staff and will NOT be accepted after 6/30/23. These forms are no longer in use with current FSD processes. In addition to forms listed above with older revision dates, the following forms are also obsolete:

Form Number Form Name
CARS-7 Food Stamp Repayment Agreement
IM-34 AEG MO HealthNet Informational Notice
  MRT Checklist
IM-115 Request for Food Stamp Household Report

 

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.
  • Begin using revised forms immediately.
  • Discard and recycle blank obsolete forms.
  • Share with community partners.

 

 

KE/cj