IM-78 OBSOLETE FORMS REMOVED FROM DEPARTMENT OF SOCIAL SERVICES (DSS) FORMS MANUAL AND INCOME MAINTENANCE (IM) FORMS MANUAL

TO: ALL FAMILY SUPPORT OFFICES

FROM: KIM EVANS, DIRECTOR

SUBJECT: OBSOLETE FORMS REMOVED FROM DEPARTMENT OF SOCIAL SERVICES (DSS) FORMS MANUAL AND INCOME MAINTENANCE (IM) FORMS MANUAL

The DSS Manuals IM Forms Manual (public site) and FSD Intranet IM Forms Manual (internal site) have both been updated to remove forms that are obsolete and no longer to be used by Family Support Division (FSD) staff.

Obsolete forms that were removed:

DOI-1	Referral for Investigation
IM-1	Application for Benefits
IM-2	Application for Benefits
IM-2	Mod Adult Adult Supplement – Spanish
IM-209	Case Reading Form
IM-23	Client Services Postcard
IM-2C	Expenses of Producing Income – Spanish
IM-2U	Eligibility Recording Form
IM-30C	Explanation of Financial Eligibility
IM-30IBCA	Income Maintenance Budget (IBCA)
IM-31A MC+	MC+ Request for Information
IM-32MC	MC+ Approval Notice (Non-premium groups)
IM-32MPW	MC+ for Pregnant Women Approval Notice
IM-32PRM	MC+ Approval Notice (Premium Group)
IM-32QMB	Notice of Approval
IM-32SLMB	Notice of Approval
IM-33A	Notice of Temporary Assistance/Food Stamp Case Action
IM-33MAF	MAF Notice of Case Action
IM-33MC	MC+ Notice of Denial
IM-33MCC	MC+ Notice of Action
IM-34	Change of Status Summary
IM-35	Identification Data Form
IM-36	Vital Statistics Form
IM-37	Insurance Form
IM-38	IM-2 Recording Worksheet
IM-3A	Reinvestigation Notice
IM-4 MA	Information about your Medical Assistance
IM-42	Inter-county Transfer
IM-42A	County Transfer Letter
IM-80MC	MC+ Advance Action Notice
PC-1	Presumptive Eligibility Determination
PC-2	MO HealthNet for Kids Presumptive Eligibility Determination
SPNDDOWN	Spend Down Calculation Document
	Audit Document Request Form
	Flow Chart for Pregnant Women Applications
	Affidavit of Disaster Loss
	Case Manager Performance Plan
	Case Worker Performance Plan
	Program Improvement Plan

KE/cj