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Get the free 461-014-0578. DHS Self-Sufficiency Administrative Rules - Previous Rule

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Previous Rules 4610140578 Eff. 12189 How to Complete the AFS505 (1)The following information must be entered on the AFS505: (a)Patient\'s Name: The name as it appears on the Medicaid Medical Card;(b)Insured\'s
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It is an administrative form used by the Department of Human Services for self-sufficiency programs.
Individuals or families participating in self-sufficiency programs may be required to file this form.
The form can be filled out online or submitted through mail following the instructions provided by the Department of Human Services.
The purpose is to collect information from participants in self-sufficiency programs to determine eligibility and provide assistance.
Personal and financial information such as income, expenses, and household composition must be reported.
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