Department of Social Services
Family Support Division
PO Box 2320
Jefferson City, Missouri
TO: ALL FAMILY SUPPORT OFFICES
FROM: KIM EVANS, DIRECTOR
SUBJECT: AUGUST 2024 – 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 IM forms show a revision date of 08/2024, unless otherwise stated.
New and Revised Forms available in the public and internal forms manuals:
| Form Number | Form Name | New or Revision: |
| IM-4MSP | Medicare Savings Program flyer | Revision to update the link to the online application. |
| IM-4MSP (Spanish) | Programa de Ahorras de Medicare | Spanish revision of IM-4MSP. |
| IM-145 | Change Report | Revision to add questions for MHN to request prior quarter coverage for new household members and to request PQ if already applied, add information about returning the change report and additional screening questions, and blue font was updated for fillable PDF to allow for readability. Revision date 7/2024. |
| IM-145 (Spanish) | Informe de Cambios | Revision of Spanish change report. Revision date 7/2024. |
New and Revised Forms available only to FSD staff in the internal forms manual:
| Form Number | Form Name | New or Revision: |
| IM-6EVS | Authorization for Verification | Revision to add the myDSS upload and remove outdated email address. |
| IM-33MAGI | Notice of Case Action | Revision to remove Transitional heading. |
| IM-33MAGI (Spanish) | Notification de Accion en su Caso | Revision of Spanish notice. |
| IM-33TMH-R | Transitional MO HealthNet Quarterly Review Letter | Revision to remove outdated information. |
New and Revised Online Forms:
| Form Name | New or Revision: | |
| Change Report | Revision to update the online change report to match revisions. Revision date 7/2024 | |
Some forms and documents require only small revisions and older versions of documents may be accepted as valid, if the information provided on the form is correct. FSD may accept documents that have been obsoleted if the information provided is current and necessary eligibility determinations.
Note: Program applications and documents used to release information are exceptions. These forms must be the current revision, except during the transition period allowed after a new revision is posted.
NECESSARY ACTION:
- Review this memorandum with appropriate staff.
- Begin using revised forms immediately.
- Share with community partners.
KE/cj