Indiana Family and Social Services Administration Forms
The Indiana Family and Social Services Administration (FSSA) is responsible for providing a wide range of programs and services to support Hoosier families and individuals. FSSA administers programs related to healthcare, nutrition assistance, child welfare, Medicaid, disability services, aging and adult services, and more. Their main goal is to ensure that all individuals and families in Indiana have access to the resources and support they need to thrive.
Documents:
30
This form is used for consenting to a licensed child care center or home in Indiana.
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Word
This Form is used for assessing the risk of falls in the state of Indiana.
This document provides guidance and information on the orientation process for new employees in the state of Indiana. It covers important topics such as company policies, procedures, and expectations.
This form is used for filing an administrative appeal and requesting a hearing in the state of Indiana.
This Form is used for selecting an authorized representative for health coverage in Indiana.
This Form is used for authorizing the disclosure of personal and health information in the state of Indiana.
This form is used for revoking authorization in the state of Indiana.
This Form is used for designating a protective payee for the Hoosier Works Card in Indiana.
This form is used for applying for SNAP and cash assistance in the state of Indiana.
This Form is used for applying for SNAP and cash assistance in Indiana. (Spanish)
State Form 55367 (DFR0009M) Notice Regarding Rights & Responsibilities for Health Coverage - Indiana
This form is used for providing a notice to Indiana residents about their rights and responsibilities regarding health coverage.
This Form is used for voluntary clients in Indiana to understand their impact responsibilities, sanctions, and rights.
This Form is used for informing individuals in Indiana about their rights and responsibilities for the Supplemental Nutrition Assistance Program (SNAP) and Cash Assistance.
This document is used for providing notice of rights and responsibilities for health coverage in Indiana.
This Form is used for applying for SNAP (Food Stamps) and cash assistance in Indiana. It is specifically for individuals who speak Burmese.
This form is used to provide notice related to the rights and responsibilities of the Supplemental Nutrition Assistance Program and Cash Assistance program in Indiana.
This form is used in Indiana to create an Individualized Family Service Plan (IFSP) for children with special needs. The purpose is to enhance the capacity of families to support their children's specific needs.
This form is used for informing job applicants in Indiana about their rights and responsibilities during the job search process.
This type of document, Formulario del Estado 55371 (DFR2123S) Representante Autorizado Cobertura De Salud - Indiana, is used for obtaining authorized representation for health coverage in the state of Indiana.
This document is used for legislative inquiries in Indiana. It authorizes someone to act on behalf of a constituent.
This document is used for registering attendance for the Impact Program for Vocational Education / Labor Skills Training in Indiana.
This Form is used for applying for the Medicare Savings Program in Indiana.
This Form is used for designating an authorized representative for SNAP (Food Assistance) and Cash Assistance in Indiana.
This form is used for Snap volunteers in Indiana to understand their rights and responsibilities. It outlines the impact these volunteers can make and the expectations placed upon them.
This form is used for claiming financial assistance to help cover funeral and cemetery expenses in the state of Indiana.
This form is used for recording and tracking a patient's intake and output of fluids in the state of Indiana. It helps healthcare providers monitor fluid balance and assess patient hydration levels.
