Learn about the Medicaid 1115 Transformation Waiver Renewal.
For information about COVID-19, call 2-1-1 and select Option 6.
Find a COVID-19 testing site | COVID-19 vaccine | More COVID-19 information
Downloading a Form to Your Computer
Fillable forms cannot be viewed on mobile or tablet devices. Follow the steps below to download and view the form on a desktop PC or Mac.
- Right Click for PC or Ctrl + Click for Mac on the PDF link and click “Save link as” from the menu.
- Select the folder you want to save the file in and then click "Save."
- Navigate to the folder you saved the file in and Right Click for PC or Ctrl + Click for Mac, then select "Open With" from the menu and select Adobe Acrobat Reader DC.
Note: Open the PDF file from your desktop or Adobe Acrobat Reader DC. Do not click on the downloaded file at the bottom of the browser since it will not open the PDF in Adobe Acrobat Reader DC. It will try to open the file in the browser that results in the same browser error message.
To serve as verification that a Temporary Assistance for Needy Families (TANF) or medical programs client has contacted a family violence specialist for a good cause recommendation or family violence exemption.
When to Prepare
The family violence specialist completes the form indicating that an initial assessment has been made and making a recommendation for good cause or the family violence exemption.
The specialist completes and sends the form to the advisor within five days of the assessment.
Number of Copies
Complete an original only.
File the original under the Child Support tab or the Family Violence logical unit of work (LUW).
Refer to the Manager's Guide for form retention information.