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Reconsideration of Assessment of
Suitability of a Child for Residential Treatment
Child Information
NAME:MEDICAID NUMBER:DATE OF BIRTH:GENDER:Asocial SECURITY NUMBER:FemaleCOUNTY OF ORIGIN:CIRCUIT:AREA:EVALUATOR:DATE
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Who needs mdhhs-5977 residential funding request?
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Individuals or organizations seeking funding for residential purposes from the Michigan Department of Health and Human Services (MDHHS) are the ones who need to fill out mdhhs-5977 residential funding request.
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What is mdhhs-5977 residential funding request?
The mdhhs-5977 residential funding request is a form used to request funding for residential services provided by the Michigan Department of Health and Human Services.
Who is required to file mdhhs-5977 residential funding request?
Service providers who offer residential services funded by the Michigan Department of Health and Human Services are required to file the mdhhs-5977 residential funding request.
How to fill out mdhhs-5977 residential funding request?
To fill out the mdhhs-5977 residential funding request, service providers must provide detailed information about the services offered, number of clients served, and budgetary needs.
What is the purpose of mdhhs-5977 residential funding request?
The purpose of the mdhhs-5977 residential funding request is to allocate funding for residential services to ensure that individuals receive the necessary support and care.
What information must be reported on mdhhs-5977 residential funding request?
Service providers must report information such as number of clients served, types of services provided, budgetary needs, and any additional supporting documentation.
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