Form Number |
Form Name |
New or Revision: |
CARS-8 |
Request for Reduction of Claim |
Revision to update the Department of Social Services (DSS) logo. |
CS-9
CS-9 (Spanish)
|
Changing Support Order |
Revision to update the DSS logo. This flyer has a 9/2023 revision date. |
IM-1ABDS
IM-1ABDS (Large Print)
IM-1ABDS (Spanish) |
Aged, Blind, and Disabled Supplement |
Revision to update the DSS logo.
|
IM-1BC |
Breast and Cervical Cancer Treatment (BCCT) MO HealthNet Application |
Revision to update the DSS logo. |
IM-1CC
IM-1CC (Large Print)
IM-1CC (Spanish)
|
Application for Child Care Subsidy |
Revision to update the DSS logo. |
IM-1MAC
IM-1MAC(Spanish) |
MO HealthNet Application Addendum: Request to Add Cash Benefits |
Revision to update the DSS logo. |
IM-4MLIS
|
Multi-Language Interpreter Services |
Revision to update the DSS logo. |
IM-6AR
IM-6AR (Large Print)
IM-6AR (Spanish) |
Appointing an Authorized Representative |
Revision to update the DSS logo. |
IM-31F
IM-31F (Spanish) |
Applying for SNAP Benefits |
Revision to update the DSS logo. |
IM-31V
|
Allowed Verification |
Revision to update the DSS logo. |
IM-50AA
|
Information Notice – Regarding Action Taken on Your Case – Accuity |
Revision to update the DSS logo. |
IM-50AFGE
|
Information Notice – Regarding Action Taken on Your Case – Accurint |
Revision to update the DSS logo. |
IM-50E
|
Information Notice – Regarding Action Taken on Your Case – Equifax |
Revision to update the DSS logo. |
IM-80A
|
Waiver of 10 Day Advance Notice |
Revision to update the DSS logo. |
IM-85
|
Online Hearing Request |
Revision to update the DSS logo. |
IM-86
|
Online Cancel Hearing Request |
Revision to update the DSS logo. |
IM-114
|
Voluntary Repayment Authorization Form |
Revision to update the DSS logo. |
IM-150
|
Suspending Incarcerated Participants |
Revision to update the DSS logo. |
IM-151
|
Inpatient Coverage for Incarcerated Participants |
Revision to update the DSS logo. |
IM-152
|
Restoring a Suspended Participant Change Report |
Revision to update the DSS logo. |
IM-153
|
Applying for Incarcerated Participants in Department of Corrections |
Revision to update the DSS logo. |
IM-161A
|
Withdrawal of Waiver of Administrative Disqualification Hearing Consent Agreement |
Revision to update the DSS logo. |
IM-312VAV
|
Veterans Administration Verification (Vendor) |
Revision to change form number (previously FA-312) and update the DSS logo. |
IM-312VAL
|
Veterans Administration Vendor Letter |
Revision to change form number (previously FA-313) and update the DSS logo. |
IM-365P
|
Emergency MO HealthNet Care for Ineligible Aliens (EMCIA) Provider Request |
Revision to update the DSS logo. |
IM-583CCO
|
Childcare Outreach flyer |
Revision to add a form number and update the DSS logo. |
IM-583SO
IM-583SO (Spanish)
|
School Outreach flyer |
Revision to add a form number and update the DSS logo. |