- ALL FAMILY SUPPORT DIVISION OFFICES
- PATRICK LUEBBERING, ACTING DIRECTOR
- NEW IM1-SSL SUPPLEMENTAL FORM AND PARTICIPANT SUPPLEMENTAL FORM LETTER FOR ONLINE MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED APPLICATIONS WITH MO HEALTHNET FOR FAMILIES COVERAGE NEED
- FORMS MANUAL #2
When participants submit a MO Web Application for the MO HealthNet for the Aged, Blind or Disabled program, but indicate a MO HealthNet for Families program need such as pregnancy or coverage for an individual who does not claim to be aged, blind or disabled, staff will send:
- An IM1-SSL Supplemental form to capture information needed for a MO HealthNet for Families program application;
- Any necessary application appendices; and
- A Participant Supplemental Form Letter.
On the Participant Supplemental Form Letter, staff will need to:
- Fill in the participant's address
- Check all applicable boxes
- Fill in the date that the Participant Supplemental Form Letter is due back to FSD.
NOTE: The due date will be 15 days after the date of the letter. If the due date falls on a weekend or holiday, the due date should reflect the following business day.
Applicants are instructed to send completed IM1-SSL Supplemental forms and accompanying paperwork to the Joplin Processing Center.
- Review this memorandum with appropriate staff.