Helpful Forms

• Actual or Suspected Abuse Assessment Tools
• Applicant Recipient Authorization for Release of Information
• Application for Child Care Benefits
• Application for Child Support Services Non-Public Assistance Applicant
• Application for Help with Medicare Expenses
• Application for Health Coverage & Help Paying Costs
• Cash and Food Assistance Interim Report
• Child Support - Explanation of State Hearing Procedures
• Child Support Enforcement Agency Administrative Adjustment Forms
• Child Support Enforcement Agency Questionnaire
• Combined Programs Application
• CSEA - Affidavit
• CSEA - Appointment of Authorized Person Form
• CSEA - Instruction for Obtaining Medical Verification of Reported Inability to be Gainfully Employed
• CSEA - Medical Information Release Authorization
• CSEA - PIN Request Form
• CSEA - Request for Medical Verification of Inability to be Gainfully Employed
• CSEA - Seek Work Form
• Designation of Authorized Representative
• Employment Information
• Food Assistance Change Reporting
• Healthcheck and Pregnancy Assessment
• Logan County Prevention, Retention, Contingency Application (PRC)
  
• Request for an Administrative Review of the Child Support Order
• Request for Cash, Food, and Medicare Assistance
• Request for Medicaid - Home and Community Based Services
• Request to Reapply for Cash and Food Assistance
• Uniform Report for Adult Abuse, Neglect, and Exploitation