ND DHS SFN 1812 2020-2025 free printable template
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ICF/DID PHYSICIAN CERTIFICATION AND RECERTIFICATION
NORTH DAKOTA DEPARTMENT OF HUMAN SERVICES
DEVELOPMENTAL DISABILITIES DIVISIONClear Fieldsman 1812 (92020)Federal regulation 42 CFR 456.360 requires
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How to fill out ND DHS SFN 1812
How to fill out ND DHS SFN 1812
01
Obtain the ND DHS SFN 1812 form from the official website or your local DHS office.
02
Start with Section 1, which requires you to provide the individual's name, address, and date of birth.
03
In Section 2, indicate the type of service the individual is applying for.
04
Move to Section 3 and fill in the information regarding the individual's household members.
05
Section 4 requires you to list the income sources and amounts for the household.
06
Review the form for accuracy and completeness.
07
Sign and date the form at the bottom.
08
Submit the completed form to your local DHS office or as instructed.
Who needs ND DHS SFN 1812?
01
Individuals or families seeking assistance with social services, including food assistance, housing support, or medical benefits.
02
Those who are applying for or renewing eligibility for services provided by the North Dakota Department of Human Services.
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What is ND DHS SFN 1812?
ND DHS SFN 1812 is a form used in North Dakota for reporting and documenting applications for the Child Care Assistance Program.
Who is required to file ND DHS SFN 1812?
Individuals or families applying for financial assistance for child care services in North Dakota are required to file ND DHS SFN 1812.
How to fill out ND DHS SFN 1812?
To fill out ND DHS SFN 1812, complete all required fields with accurate information about your family, income, and child care expenses, then submit the form to the appropriate agency.
What is the purpose of ND DHS SFN 1812?
The purpose of ND DHS SFN 1812 is to assess eligibility for the Child Care Assistance Program and to determine the amount of financial assistance that can be provided to families.
What information must be reported on ND DHS SFN 1812?
The information that must be reported on ND DHS SFN 1812 includes family size, income details, child care provider information, and any other relevant financial data.
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