Department of Social Services
Family Support Division
PO Box 2320
Jefferson City, Missouri
TO: ALL FAMILY SUPPORT OFFICES
FROM: KIM EVANS, DIRECTOR
SUBJECT: JANUARY 2024 – QUARTERLY FORMS UPDATE
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 IM forms show a revision date of 01/2024, unless otherwise stated. Revised IM forms with older revisions dates are now obsolete. Family Support Division (FSD) will accept obsolete forms until 03/31/2024.
Note: Child Care program information was removed from many FSD forms and documents as Department of Elementary & Secondary Education (DESE) systems are used for eligibility (2023 Memo IM-103).
Participants may access the Application for Child Care Subsidy for Children and Families (MO 500-3469) and additional information from the Child Care Subsidy Information for Families webpage on the DESE website.
|New or Revision:
IM-4Finding Help (Spanish)
|Finding Help brochure
|Revision –removed the Child Care program information. Revision date (12/2023)
|IM-4 Employment Impacts Benefits
IM-4 Employment Impacts Benefits (Spanish)
|How Employment Impacts Your Benefits flyer
|Revision – removed the Child Care program information.
IM-4Spend Down (Spanish)
|Spend Down flyer
|Revision – added information about paying online using the My MOHealthNet Portal, corrected the link to the Spend Down Frequently Asked Questions.
IM-6AR (Large Print)
|Appointing an Authorized Representative
|Revision – removed references to Child Care program, added instructions for returning the completed form to FSD.
|Your Rights and Responsibilities as a Supplemental Nutrition Assistance Program (SNAP) Household
|New – Spanish translation of IM-31B (8/2023)
|Revision – removed references to Child Care program.
|MO HealthNet Undue Hardship Waiver Request
|Revision – updated language and formatting, moved form to public forms manual from internal forms manual
|Request to Withdraw or Close
|Revision – removed Child Care Program, added MO HealthNet Children’s Insurance Program (CHIP), reformatted program list
New and Revised Online Forms
|New or Revision
|Revision – updated to match IM-110 (9/2023) by updating non-discrimination language.
New and Revised Forms available only to FSD staff in the internal forms manual:
|New or Revision
|IM-32 MAGI (Spanish)
|MO HealthNet Approval Notice
|Revision – Spanish translation of IM-32 MAGI (12/2023)
IM-33 MAGI (Spanish)
|Notice of Case Action
|Revision – updated formatting, updated legal references, updated hearing and report changes language
|MO HealthNet Undue Hardship Waiver Decision
|Revision – updated language
|MO HealthNet Undue Hardship Waiver Notice
|Revision – changed form name, updated hearings and report changes language
Obsolete forms should no longer be used by FSD staff. 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:
IM-1CC (Large Print)
Child Care Application
|Child Care Subsidy Brochure
|Child Care Fraud Brochure
|Units of Care Calculation Worksheet
- Review this memorandum with appropriate staff.
- Begin using revised forms immediately.
- Discard and recycle blank obsolete forms.
- Share with community partners.