Forms for Division of Senior Benefits and Utilization Management
Forms
|
| Form # |
Title |
PDF/WORD |
Instruction/ Comments |
| AP-2 |
Universal Application for PAAD, Senior Gold and Other Special Benefit Programs (for individuals applying for PAAD or Senior Gold benefits for the first time) |
|
|
| AP-5 |
Electronic Data Interchange (EDI) Enrollment Form |
pdf 56k
doc 36k |
|
| HA-1 |
Eligibility Application, Hearing Aid Assistance for the Aged and Disabled (HAAAD) |
pdf 16k
doc 40k |
|
|
DHSS Forms
