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Product # Size Description Price
CGVRGUIDCPSR12-14EN C CAREGIVER'S GUIDE TO CPS INVESTIGATION REV 12-14 ENG $16.88
CGVRGUIDCPSR12-14SP C CAREGIVER'S GUIDE TO CPS $16.88
CHLDINFOSTRCR12-14EN C WHEN YOUR CHILD IS PLACED IN FOSTER CARE REV 12-14 ENGLISH $16.88
CHLDINFOSTRCR12-14SP C WHEN YOUR CHILD IS PLACED IN FOSTER CARE REV 12-14 SPANISH $16.88
CITIZENSHIP AFFIDAVI C CITIZENSHIP AFFIDAVIT $1.65
DHR-197 REV 9-05 C TANF Sanction/Panel Review Guide $3.90
DHR-206 REV 11-07 C Disposition Notification-TSS $1.80
DHR-281 REV 3-09 C GRG Monthly Subsidy/CRISP Payments $4.90
DHR-282 REV 3-09 C GRG Notification Form $4.90
DHR-283 REV 3-96 C DFCS Systems Password Agreement $4.90
DHR-357 REV 3-07 C Request for SUCCESS Worker ID $13.10
DHR-491P2OF4 REV4-06 PK Employment Services Family Assessment Pg 2 of 4 $2.86
DHR-491P3OF4 REV4-06 PK Employment Services Family Assessment Pg 3 of 4 $2.86
DHR-520 REV 10-07 C Leaving Welfare For Work Broch $10.30
DHR-521 REV 11-06 C DHR Services Brochure $4.60
DHR-523 REV 3-03 C Family Violence Option Assessment Report $4.90
DHR-6000A REV 5-06 C Applic for Energy Assist Cooling (Blue) $7.90
DHR-786-1 REV 4-04 C TANF Notice of Family Cap Rule $4.90
DHR-806P10F2 REV1-10 C MEDICAL STATEMENT Pg 1 of 2 $5.90
DHR-831 REV 12-04 C Emergency Food Assist Program Brochure $3.20
DHR-963 REV 1-07 C Medicaid Notification Form $5.90
DHR-981SP REV 11-08 C Contact Ltr/Wage Ver Cklist ABD Med (Sp) $11.80
DHR491P1OF4 REV4-06 PK Employment Services Family Assessment Pg 1 of 4 $2.86
DHR491P4OF4 REV4-06 PK Employment Services Family Assessment $2.86
DHR806P2OF2REV1-10 C MEDICAL STATEMENT Pg 2 of 2 $5.90
DHS-1275 REV 3-15 C VOTER REGISTRATION APPLICATION $2.02
DHS-1275A REV 7-16 C LOCAL DFCS LISTING $2.00
DHS-1276 REV 5-12 C VOTER REGISTRATION DECLARATION STATEMENT $1.70
DHS-1277 C ST OF GA APP FOR VOTER REGISTRATION $6.00
DHS-130 REV 7-14 C TANF FAM MEDICAID CHILD MEDICAL SUPP LTR $5.95
DHS-138 REV 10-12 C NOTICE OF REQUIREMENT TO COOPERATE $1.80
DHS-139 REV 2-10 C CONTRIBUTION STATEMENT $5.50
DHS-139SP REV 2-10 C CONTRIBUTION STATEMENT (SP) $5.95
DHS-173 REV 6-10 C VERIFICATION CHECKLIST $4.50
DHS-173A REV 8-15 C APPOINTMENT LETTER 100/PK $4.80
DHS-173ASP REV 8-15 C APPOINTMENT LETTER (SP) 100/PK $4.90
DHS-173SP REV 6-10 C VERIFICATION CHECKLIST (SP) $5.88
DHS-194 REV 2-10 C TANF ASSESSMENT FOR DOMESTIC VIOLENCE $4.90
DHS-218 REV 1-14 C CITIZENSHIP/IDENTITY VERIFY CKLIST $4.95
DHS-218SP REV 1-14 C CITIZENSHIP/IDENTITY VERIFY CKLIST (SP) $5.00
DHS-219 REV 10-12 C AFFIDAVIT CITIZENSHIP $1.95
DHS-219SP REV 10-12 C AFFIDAVIT CITIZENSHIP (SP) $1.95
DHS-238 REV 8-11 C MEDICALLY NEEDY BUDGET SHEET $1.85
DHS-249 REV 3-11 C NOTIFICATION FORM $5.90
DHS-296 REV 1-17 C EXPEDITED FOOD STAMP 50# WHITE OFFSET 8.5X11 $1.80
DHS-297 REV 11-15 C APPLICATION FOR BENEFITS $15.75
DHS-297A REV 11-15 C RIGHTS AND RESPONSIBILITIES $12.60
DHS-297ASP REV 11-15 C RIGHTS AND RESPONSIBILITIES SPANISH $12.60
DHS-297M REV 1-14 C MEDICAID ADDENDUM $4.75
DHS-297MSP REV 1-14 C MEDICAID ADDENDUM (SP) $4.75
DHS-297SP REV 11-15 C APPLICATION FOR BENEFITS SPANISH $15.75
DHS-354 REV 2-15 C EXPENSE STATEMENT $1.80
DHS-354SP REV 2-15 C EXPENSE STATEMENT (SP) $1.80
DHS-489 REV 8-09 C TANF Work Requirement Exemption Form $5.72
DHS-495 REV 09-14 C JOB SEARCH RECORD $4.90
DHS-495SP REV 09-14 C JOB SEARCH RECORD (SP) $4.90
DHS-504 REV 8-09 C ADA Section 504 Notice $4.90
DHS-505 REV 1-16 C TANF ADA COMPLIANCE CHECKLIST $4.90
DHS-508 REV 11-15 C FOOD STAMP/MEDICAID/TANF RENEWAL FORM ENGLISH $15.45
DHS-508SP REV 11-15 C FOOD STAMP/MEDICAID/TANF RENEWAL FORM SPANISH $15.45
DHS-516 REV 1-14 C RECORD OF ATTENDANCE AND PERFORMANCE REP $10.30
DHS-522 REV 2-13 C WHAT EVERY WOMAN NEEDS TO KNOW BROCHURE $4.20
DHS-522SP REV 2-13 C WHAT EVERY WOMAN NEEDS TO KNOW BROCHURE (SP) $4.20
DHS-524 REV 11-15 C TEMPORARY ASSIST FOR NEEDY FAMILIES $3.16
DHS-524SP REV 11-15 C TEMPORARY ASSIST FOR NEEDY FAMILIES $3.20
DHS-5459 REV 10-11 C AUTHORIZATION FOR RELEASE OF INFORMATION $1.80
DHS-5460 REV 4-16 C HIPAA FORM ENGLISH $7.48
DHS-5460SP REV 4-16 C HIPAA FORM SPANISH $7.48
DHS-5667 REV 2-11 C HEAD OF HOUSEHOLD INFORMATION $5.90
DHS-6000 REV 10-15 C APPLICATION FOR ENERGY ASSISTANCE $8.05
DHS-6003 REV 11-10 C EAP INCOME WORKSHEET RENT VERIFICATION $1.70
DHS-6004 REV 8-16 C Low Income Home EAP Inf Notice $1.80
DHS-6005 REV 10-11 C REGULATED NATURAL GAS PROVIDER REFERRAL $12.50
DHS-6008 REV 5-16 C EAP - Informal Conference Summ $1.70
DHS-6009 REV 11-10 C EAP VERIFICATION CHECKLIST $7.90
DHS-6019 REV 11-10 C EAP BATCH HEADER $7.90
DHS-6020 REV 11-10 C ERROR CORRECTION FORM $7.90
DHS-6021 REV 11-10 C EAP - DECLARATION OF ZERO INCOME $1.70
DHS-6022 REV 10-15 C LIHEAP AUTHORIZATION FOR RELEASE $1.83
DHS-700 REV 5-11 C Q-TRACK APPLICATION $5.35
DHS-700SP REV 5-11 C Q-TRACK APPLICATION (SP) $5.35
DHS-701 REV 10-12 C Q-TRACK BROCHURE $5.65
DHS-785 REV 6-12 C FAMILY PLANNING SERVICES REFERRAL $7.90
DHS-809 REV 10-12 M Verification of Earned Income $4.50
DHS-835 REV 4-11 C COMPASS ID CARDS $0.90
DHS-835SP REV 4-11 C COMPASS ID CARDS (SP) $0.90
DHS-854 REV 5-11 C APPLICATION GA DISASTER FOOD STAMP PROG $2.56
DHS-854SP REV 5-11 C APPLICATION GA DISASTER FOOD STAMP PROG (SP) $2.44
DHS-855 REV 5-11 C DISASTER FOOD STAMP PROGRAM WORKSHEET $4.90
DHS-855SP REV 5-11 C DISASTER FOOD STAMP PROGRAM WORKSHEET (SP) $4.90
DHS-901 REV 11-15 C COMMODITY SUPPLEMENTAL FOOD PROGRAM APPLICATION $0.00
DHS-901SP REV 11-15 C COMMODITY SUPPLEMENTAL FOOD PROGRAM APPLICATION (SP) $0.00
DHS-902 REV 11-15 C ELIGIBILITY NOTIFICATION LETTER $0.00
DHS-902SP REV 11-15 C ELIGIBILITY NOTIFICATION LETTER (SP) $0.00
DHS-903 REV 11-15 C PARTICIPANT AGREEMENT $0.00
DHS-903SP REV 11-15 C PARTICIPANT AGREEMENT (SP) $0.00
DHS-904 REV 11-15 C CLOSURE NOTIFICATION LETTER $0.00
DHS-904SP REV 11-15 C CLOSURE NOTIFICATION LETTER (SP) $0.00
DHS-905 REV 11-15 C VERIFICATION OF CERTIFICATION FORM $0.00
DHS-905SP REV 11-15 C VERIFICATION OF CERTIFICATION FORM (SP) $0.00
DHS-906 REV 11-15 C DISQUALIFICATION NOTICE $0.00
DHS-906SP REV 11-15 C DISQUALIFICATION NOTICE SPANISH $0.00
DHS-907 REV 11-15 C AUTHORIZED REPRESENTATIVE DESIGNATION $0.00
DHS-907SP REV 11-15 C AUTHORIZED REPRESENTATIVE DESIGNATION (SP) $0.00
DHS-908 REV 9-15 C NUTRITION EDUCATION ACTIVITY SHEET $0.00
DHS-909 REV 9-15 C WAITING LIST $0.00
DHS-910 REV 9-15 C ISSUANCE REGISTER $0.00
DHS-911 REV 9-15 C LDA MONTHLY FOOD DISTRIBUTION REPORT $0.00
DHS-912 REV 11-15 C VERIFICATION CHECKLIST $0.00
DHS-912SP REV 11-15 C VERIFICATION CHECKLIST (SP) $0.00
DHS-913 REV 9-15 C RECERTIFICATION FORM $0.00
DHS-914 REV 11-15 C RECERTIFICATION STATUS NOTIFICATION $0.00
DHS-914SP REV 11-15 C RECERTIFICATION STATUS NOTIFICATION (SP) $0.00
DHS-915 REV 11-15 C RECERTIFICATION LETTER A $0.00
DHS-915SP REV 11-15 C RECERTIFICATION LETTER A (SP) $0.00
DHS-916 REV 11-15 C RECERTIFICATION LETTER WL $0.00
DHS-916SP REV 11-15 C RECERTIFICATION LETTER WL (SP) $0.00
DHS-919 REV 11-16 C CSFP WRITTEN NOTICE FORM 2 PART - 1 SIDE $0.00
DHS-920 REV 11-16 C CSFP BENEFICIARY REFERRAL REQUEST FORM - 2 PART- 1 SIDE $0.00
DHS-94A REV 1-14 C APPLICATION FOR HEALTH COVERAGE & HELP PAYING COST $20.00
DHS-94A SP REV 1-14 C APPLICATION FOR HEALTH COVERAGE & HELP PAYING COST SP $20.00
DHS-95 REV 10-12 C CONTACT LTR CKLIST FOR FAMILY MEDICAID $4.95
DHS-95SP REV 10-12 C CONTACT LTR CKLIST FOR FAMILY MEDICAID $4.95
DHS-962 REV 5-12 C CERTIFICATION OF MEDICAID $8.00
DHS-981 REV 3-11 C CONTACT LETTER/WAGE VERIF CKLIST ABD MED $5.90
DHS-985 REV 2-10 C ABD MEDICAID BURIAL DESIGNATION $1.80
DHS216ENG-SP REV1-14 C DECLARATION OF CITIZENSHIP/ ALIEN STATUS $1.82
DHS339ENG-SPREV9-15 C SIMPLIFIED REPORTING REQ (SSR) 100/PK $1.80
DHS819ENG-SP REV5-12 C DFCS CUSTOMER CONTACT CENTER CARDS $0.90
DHS830EN-SP REV1-16 C SNAP WORKS GA'S EMPLOYMENT & TRAINING PROGRAM $0.00
DHS880ENG-SP REV7-10 C VERIFICATION CASE MGR MAY ASK APPLIC F S $1.80
DHS94A APX A REV1-14 C HEALTH COVERAGE FROM JOBS $2.64
DHS94A APX B REV1-14 C AMERICAN INDIAN OR ALASKA NATIVE FAMILY MEMBER $2.04
DHS94A APX C REV1-14 C ASSISTANCE WITH COMPLETING THIS APPLICATION $2.04
DHS94ASP AP A RV1-14 C HEALTH COVERAGE FROM JOBS (SP) $2.64
DHS94ASP AP B RV1-14 C AMERICAN INDIAN OR ALASKA NATIVE FAMILY MEMBER (SP) $2.04
DHS94ASP AP C RV1-14 C ASSISTANCE WITH COMPLETING THIS APPLICATION (SP) $2.04
FSSCAREGUIDENGR12-14 C FAMILY SUPPORT SERVICES CAREGIVER'S GUID ENG REV 12-14 $16.88
FSSCAREGUIDSPR12-14 C FAMILY SUPPORT SERVICES CAREGIVER'S GUIDE SP REV 12-14 $16.88
GASRSNAP REV 7-16 C GA SENIOR SNAP PROJECT $0.00
HLPKEPCHLDSFR12-14EN C HELPING KEEP CHILDREN SAFE REV 12-14 ENG $16.88
HLPKEPCHLDSFR12-14SP C HELPING KEEP CHILDREN SAFE REV 12-14 SPANISH $16.88
PICTURE A GED C Picture yourself with a GED $0.00
SAFERESCGUIDR12-14EN C SAFETY RESOURCE CAREGIVER'S GUIDE REV 12-14 ENG $16.88
SAFERESCGUIDR12-14SP C SAFETY RESOURCE CAREGIVER'S GUIDE REV 12-14 SP $16.88
SAFETYPLAN ENGR12-14 C GEORGIA SAFETY PLAN $4.95
SAFETYPLAN SPR12-14 C GEORGIA SAFETY PLAN ( SP) $4.95
SNAPETPILOT REV 8-16 C SNAP E & T PILOT FLYER $0.00
SNAPWRKS2.0EN R 8-16 C SNAP WORKS 2.0 ENG FLYER $0.00
SNAPWRKS2.0SP R 8-16 C SNAP WORKS 2.0 SP FLYER $0.00