M E M O R A N D U M

IM-50  04/26/02 MC-4 AND MC-4A REVISION
FORMS MANUAL REVISION #14


SUBJECT:
FORMS MANUAL REVISION #14:
MC-4 IMPORTANT INFORMAITON AND MC-4A
MC+ INCOME GUIDELINES
 
DISCUSSION:
The MC-4 and MC-4A has been revised to reflect the elimination of the Custodial Parent Program.  Additional information has been added to the MC-4 with regard to drug dispensing fees and cost sharing.  The MC-4A was revised to reflect the April 2002 federal poverty level guidelines.

There has been no change in policy for use of these forms.

An initial supply will be sent when printed.  Additional forms may be ordered through the warehouse.
NECESSARY ACTION:
  • Review this memorandum with appropriate staff.
  • Destroy the current supply of MC-4 and MC-4As upon receipt of an initial supply.
  • File the revised forms and instructions in the Forms Manual.
CSW
Distribution # 2
Attachment not available online.
IM-49
[ 2002 Memorandums ]
 IM-51