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MFP Participant Face Sheet Form F Date: Participant Name: Date of Birth: IN #: Participant Address Participant Phone #: Emergency contact Name: Emergency contact Phone #: Transition coordinator name:
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01
Start by writing your personal information, including your name, date of birth, address, phone number, and email address.
02
Indicate your gender, ethnicity, and primary language spoken.
03
Provide your social security number and Medicaid ID number, if applicable.
04
Fill out your marital status and indicate if you have any dependents.
05
Specify your current housing situation and whether you receive any rental assistance.
06
If applicable, provide information about your income, including wages, benefits, and any other sources of income.
07
Indicate if you have any health insurance coverage, such as Medicaid or Medicare.
08
Mention any special health conditions or disabilities you may have.
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List any current medications you are taking.
10
Provide details about your current employment status, including your employer's name, address, and contact information.
11
If you are currently a student, provide information about your educational institution.
12
Sign and date the form to confirm its accuracy.

Who needs mfp participant face sheet:

01
Individuals who are applying for or participating in the Money Follows the Person (MFP) program.
02
Participants who are transitioning from institutional care to community-based care.
03
Individuals who may require long-term care services and supports.
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The MFP Participant Face Sheet is a form used to collect information about participants in the Market Facilitation Program (MFP) administered by the USDA.
Farmers and producers who are participating in the Market Facilitation Program (MFP) are required to file the MFP Participant Face Sheet.
The MFP Participant Face Sheet can be filled out online or in person at a USDA office. Farmers and producers must provide accurate information about their operation and crops.
The purpose of the MFP Participant Face Sheet is to gather information about participants in the Market Facilitation Program (MFP) in order to administer program payments.
Participants must report information such as their name, contact information, farm operation details, types of crops grown, and acreage.
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