Eligibility Determination Templates

This Form is used for collecting data to determine initial IV-E eligibility for Kansas residents.

This document is for residents of California who have applied for Disaster CalFresh assistance. It provides information on whether their application has been approved or denied.

This form is used to request eligibility determination for DDA (Developmental Disabilities Administration) services in Washington state.

This report provides monthly data on applications, eligibility determinations, and enrollment for the Medicaid and Children's Health Insurance Program (CHIP) in March 2015. It helps analyze the usage and effectiveness of these healthcare programs in the United States.

This form is used to determine eligibility for federal AFDC-FC (Aid to Families with Dependent Children-Foster Care) in California.

This form is used for sharing information with external parties in order to determine eligibility for certain benefits or services in the state of Missouri.

This Form is used for determining eligibility for certain programs or benefits in the state of Maryland.

This document is used for determining if an individual or organization is eligible for receiving benefits or services under Section 504 of the Rehabilitation Act.

This document is used for determining eligibility for specific learning disabilities in the state of Arkansas. It outlines the criteria and process for determining whether a student qualifies for special education services due to a specific learning disability.

This form is used for documenting the findings related to Form H1852 in the state of Texas.

This form is used for retroactively certifying the eligibility of nonmedical out-of-home care (NMOHC) payment standards for the Cash Assistance Program for Immigrants (CAPI) in California.

This Form is used for determining the eligibility of immigrants in California for nonmedical out-of-home care payments under the Cash Assistance Program.

This form is used for determining eligibility for home and community-based services in South Dakota.

This form is used to determine the eligibility of a child under the age of 21 who is in foster care or subsidized adoption under the Maryland Department of Human Services.

This Form is used for determining adult eligibility for the Workforce Innovation and Opportunity Act (WIOA) program in Arkansas.

This form is used for determining the eligibility of out-of-school youth for the Out-of-School Youth Program under the Workforce Innovation and Opportunity Act (WIOA) in Arkansas.

This Form is used for determining the eligibility of dislocated workers for the Dislocated Worker Program under the Workforce Innovation and Opportunity Act (WIOA) in the state of Arkansas.

This form is used for determining the eligibility of in-school youth for the Workforce Innovation and Opportunity Act (WIOA) program in Arkansas.

This form is used to request a state fair hearing in California to appeal a Covered California eligibility determination.

This form is used for applying for eligibility determination in Arizona.

This form is used to determine eligibility for the VMC program in the state of Colorado.

This form is used to determine eligibility for Section 504 accommodations in the state of Georgia, United States.

This document is a form used in the state of Georgia in the United States for evaluating and determining appropriate placement or accommodations for individuals with disabilities under Section 504 of the Rehabilitation Act.

This form is used for individuals in Pennsylvania to register as an exchange assister.

This document is used for screening and assessing the needs of children in Texas who may be eligible for special education services.

This form is used for the determination and order of eligibility and suitability for the Vorp/Community Justice Conference Program Deputy District Attorney in the County of Fresno, California.

This document is used for notifying eligible individuals about their participation in the Commodity Supplemental Food Program (CSFP) in Washington. It is specifically for those who speak Russian.

This document is a Pasrr Evaluation specific to the state of Texas. It is used to assess the need for specialized services for individuals with mental illness or intellectual disabilities.

This document is used for determining eligibility for indigent defense services in the state of Virginia.

This document is used for determining eligibility for indigent defense services in the state of Virginia. It provides instructions for completing Form DC-333 Financial Statement.