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<DIV><SPAN class=897324114-13072012><FONT face=Arial size=2>Hi Everyone,
</FONT></SPAN></DIV>
<DIV><SPAN class=897324114-13072012><FONT face=Arial size=2>Earlier this week, I
send out information about programs through the state. Today I am forwarding on
where one can apply for these programs or get more information.
</FONT></SPAN></DIV>
<DIV><SPAN class=897324114-13072012><FONT face=Arial size=2>The website where
one can apply for these programs is <A
href="http://www.marylandsail.org">www.marylandsail.org</A> </FONT></SPAN></DIV>
<DIV><SPAN class=897324114-13072012><FONT face=Arial size=2>I have posted the
verification forms which are available. </FONT></SPAN></DIV>
<DIV><SPAN class=897324114-13072012><IMG class=sectionheader
id=ctl00_cphMain_ucSection_imgHeaderImage
style="BORDER-TOP-WIDTH: 0px; BORDER-LEFT-WIDTH: 0px; BORDER-BOTTOM-WIDTH: 0px; BORDER-RIGHT-WIDTH: 0px"
alt="Verification Forms"
src="https://www.marylandsail.org/images/VerificationForms.jpg">
<DIV class=content>
<UL>
<LI><A
href="https://www.marylandsail.org/SailPDFLinks/SailPDFLinks.aspx?PDF=PVF_English_App"
target=_blank>9701 Application for Assistance (English)</A>
<P>Basic application for cash assistance, Food Stamps and Medical Assistance
programs. Includes Facts You Should Know, Application form and Rights and
Responsibilities form.</P>
<LI><A
href="https://www.marylandsail.org/SailPDFLinks/SailPDFLinks.aspx?PDF=PVF_Spanish_App"
target=_blank>9701 Solicitud Para Asistencia (Spanish)</A>
<P>Basic application in Spanish for cash assistance, Food Stamps and Medical
Assistance programs. Includes Facts You Should Know, Application form and
Rights and Responsibilities form.</P>
<LI><A
href="https://www.marylandsail.org/SailPDFLinks/SailPDFLinks.aspx?PDF=PVF_FIA9708-04"
target=_blank>9708 MA Application</A>
<P>Eligibility determination document for a child in Long Term Care, Waiver,
Kinship Care or any person under 21 not in a family.</P>
<LI><A
href="https://www.marylandsail.org/SailPDFLinks/SailPDFLinks.aspx?PDF=PVF_OHEP_Appl_English"
target=_blank>OHEP Application (English)</A>
<P>This is the Office of Home Energy application.</P>
<LI><A
href="https://www.marylandsail.org/SailPDFLinks/SailPDFLinks.aspx?PDF=PVF_OHEP_Appl_Spanish"
target=_blank>OHEP Application (Spanish)</A>
<P>This is the Office of Home Energy application in Spanish.</P>
<LI><A
href="https://www.marylandsail.org/SailPDFLinks/SailPDFLinks.aspx?PDF=PVF_FS_Change_Reporting_Guide_English"
target=_blank>Food Supplement Program Reporting Guide (English)</A>
<P>This form explains reporting requirements for families in the simplified
reporting group and for those in the change reporting group.</P>
<LI><A
href="https://www.marylandsail.org/SailPDFLinks/SailPDFLinks.aspx?PDF=PVF_FS_Change_Reporting_Guide_Spanish"
target=_blank>Food Supplement Program Reporting Guide (Spanish)</A>
<P>Guia para registrar cambios en el programa de cupones para alimentos. This
form explains in Spanish reporting requirements for families in the simplified
reporting group and for those in the change reporting group.</P>
<LI><A
href="https://www.marylandsail.org/SailPDFLinks/SailPDFLinks.aspx?PDF=PVF_491_English_Change_Report"
target=_blank>491 FIA Change Report Form (English)</A>
<P>Form in English for reporting changes in circumstances. </P>
<LI><A
href="https://www.marylandsail.org/SailPDFLinks/SailPDFLinks.aspx?PDF=PVF_491_Spanish_Change_Report"
target=_blank>491 FIA Formulario De Informe Sobre Los Cambios (Spanish)</A>
<P>Form in Spanish for reporting changes in circumstances.</P>
<LI><A
href="https://www.marylandsail.org/SailPDFLinks/SailPDFLinks.aspx?PDF=PVF_letter_0007_employer_verification"
target=_blank>0007 Employment Verification Form</A>
<P>A form for an employer to complete to verify employment information.</P>
<LI><A
href="https://www.marylandsail.org/SailPDFLinks/SailPDFLinks.aspx?PDF=PVF_Letter_0009_Dependent_Care_verification"
target=_blank>0009 Dependent Care Verification Form</A>
<P>A form for the child care or other dependent care provider to complete to
verify payments.</P>
<LI><A
href="https://www.marylandsail.org/SailPDFLinks/SailPDFLinks.aspx?PDF=PVF_Letter_0010_Insurance_verification"
target=_blank>0010 Insurance Verification Form</A>
<P>A form for an insurance company to use to verify insurance coverage.</P>
<LI><A
href="https://www.marylandsail.org/SailPDFLinks/SailPDFLinks.aspx?PDF=PVF_letter_0011_bank_verification"
target=_blank>0011 Bank Verification Form</A>
<P>A form to give to the bank to verify bank accounts.</P>
<LI><A
href="https://www.marylandsail.org/SailPDFLinks/SailPDFLinks.aspx?PDF=PVF_MedicalForm"
target=_blank>Medical Report Form 500 (replaces 402B and 402W Medical
Forms)</A>
<P>This form is completed by a health provider and used to determine
eligibility for federal and state programs using Social Security disability
criteria.</P>
<LI><A
href="https://www.marylandsail.org/SailPDFLinks/SailPDFLinks.aspx?PDF=PVF_School_Form"
target=_blank>604 School Attendance Verification Form</A>
<P>The form is completed by the parent and school official to verify school
attendance of children ages 7 - 18. This form may also be used to verify
identity for Medical Assistance programs.</P>
<LI><A
href="https://www.marylandsail.org/SailPDFLinks/SailPDFLinks.aspx?PDF=PVF_1052_English_Verification"
target=_blank>1052 Request For Information To Verify Eligibility Form</A>
<P>Check off form in English requesting documents to verify eligibility for
Family Investment programs.</P>
<LI><A
href="https://www.marylandsail.org/SailPDFLinks/SailPDFLinks.aspx?PDF=PVF_1052_Spanish_Verification"
target=_blank>1052 Pedido De Datos Para Verificar La Elegibilidad</A>
<P>Check off form in Spanish requesting documents to verify eligibility for
Family Investment programs.</P>
<LI><A
href="https://www.marylandsail.org/SailPDFLinks/SailPDFLinks.aspx?PDF=PVF_Verf_of_Rent_and_Living"
target=_blank>1130 Rent and Living Arrangements Verification Form</A>
<P>This form is used to verify rent and household composition.</P>
<LI><A
href="https://www.marylandsail.org/SailPDFLinks/SailPDFLinks.aspx?PDF=PVF_PPI_Health_Care_Form"
target=_blank>1131 Primary Prevention Initiative Health Care Form (PPI)</A>
<P>Form for physician to complete certifying that children and adults
receiving TCA meet PPI requirements.</P></LI></UL></DIV>
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<DIV class=FooterHelpclause style="FLOAT: left">
<P>If you need help please call DHR Constituent Services 1-800-332-6347
<BR>8:00am - 5:00pm Monday - Friday. <BR><FONT face="arial, helvetica"
color=#333399 size=1><B>Martin O'Malley, Governor | Anthony G. Brown, Lt.
Governor | Ted Dallas, Secretary</B> </FONT><BR><FONT face="verdana, arial"
color=#000000 size=1>This Page Last Revised on June 21, 2012 </FONT></P></DIV>
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Us</A> | <A href="http://www.dhr.state.md.us/">DHR
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href="mailto:webmaster@dhr.state.md.us">Webmaster</A> |
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<P>311 West Saratoga Street, Baltimore, MD
21201 | 1-800-332-6347</P></DIV></DIV></SPAN></DIV>
<DIV><FONT face=Arial size=2></FONT> </DIV>
<DIV align=left><FONT face=Arial size=2>Yasmin Reyazuddin </FONT></DIV>
<DIV align=left><FONT face=Arial size=2>Aging & Disability Services
</FONT></DIV>
<DIV align=left><FONT face=Arial size=2>Montgomery County Government
</FONT></DIV>
<DIV align=left><FONT face=Arial size=2>Department of Health & Human
Services </FONT></DIV>
<DIV align=left><FONT face=Arial size=2>401 Hungerford Drive (3rd floor)
</FONT></DIV>
<DIV align=left><FONT face=Arial size=2>Rockville MD 20850 </FONT></DIV>
<DIV align=left><FONT face=Arial size=2>240-777-0311 (MC311) </FONT></DIV>
<DIV align=left><FONT face=Arial size=2>240-777-1556 (personal) </FONT></DIV>
<DIV align=left><FONT face=Arial size=2>240-777-1495 (fax) </FONT></DIV>
<DIV align=left><FONT face=Arial size=2>office hours 8:30 am 5:00 pm
</FONT></DIV>
<DIV align=left><FONT face=Arial size=2>Languages English, Hindi, Urdu, Braille
</FONT></DIV>
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