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  • All fields: '830'
(749 results)



Display: 50

    • Consumable Supplies Inventory

    • *02AG024E-001* OKLAHOMA DEPARTMENT OF HUMAN SERVICES Consumable Supplies Inventory Site: Month: Year: ITEM Beginning inventory (quantity) Amount received (quantity) Amount used (quantity) Ending inventory (quantity) OKDHS revised 10-20-2003...
    • 2012-09-25
    • Service Expenditures Profile

    • *02AG023E-001* OKLAHOMADEPARTMENT OF HUMAN SERVICES OLDER AMERICANS ACT (OAA) TITLE III Service Expenditures Profile Grandparents and other relatives raising children is abbreviated GRRC. Area Agency on Aging (AAA) name OAA fiscal year Service...
    • 2012-09-25
    • Area Agency Quarterly Summary of Program Income

    • STATE OF OKLAHOMA DEPARTMENT OF HUMAN SERVICES AREA AGENCY QUARTERLY SUMMARY OF PROGRAM INCOME A.AREA AGENCY INFORMATION Area Agency name Area plan year no. Area Agency identification no. Reporting for quarter ending Month Year Area Agency address...
    • 2012-09-25
    • Cumulative Program Performance Report

    • *02AG022E-001* OKLAHOMADEPARTMENT OF HUMAN SERVICES OLDER AMERICANS ACT (OAA) TITLE III Cumulative Program Performance ReportDate: Fiscal Year reporting period: Start End Area Agency on Aging (AAA) name A, AAA STAFFING PROFILE Number of full-time...
    • 2012-09-25
    • Area Agency on Aging (AAA) Quarterly Report

    • *02AG020E-001* OKLAHOMA DEPARTMENT OF HUMAN SERVICES Area Agency on Aging (AAA) Quarterly Report Fiscal year Quarter Months AAA name AAA director This report summarizes specific AAA activities. This report is due to the appropriate OKDHS Aging...
    • 2012-09-25
    • Area Agency on Aging (AAA) Quarterly Report - A

    • *02AG021E-001* OKLAHOMADEPARTMENT OF HUMAN SERVICES Area Agency On Aging (AAA) Quarterly Report - AListed below are the Title III service categories for the National Aging Program Information System (NAPIS) report. Complete below by providing the...
    • 2012-09-25
    • Number of Meals Served

    • *02AG019E-001* OKLAHOMADEPARTMENT OF HUMAN SERVICES Number of Meals ServedNutrition site name Month and year Nutrition project name Project use only: Average number of days served per month: Average meals budgeted per day: Eligible meals budgeted...
    • 2012-09-25
    • Dietary Consultant's Report

    • *02AG025E-001* OKLAHOMA DEPARTMENT OF HUMAN SERVICES Dietary Consultant's Report Project name Date Project director Date Site/site manager Date I. Summary of month's consultation activities: Total monthly hours spent on site: Minimum of five hours...
    • 2012-09-25
    • Audit Report Transmittal

    • *02AG026E-001* OKLAHOMA DEPARTMENT OF HUMAN SERVICES Audit Report Transmittal Section I. Area Agency on Aging (AAA) name. Check one: Areawide ASCOG COEDD EODD KEDDO Grand Gateway NODA OEDA SWODA SODA Tulsa Tulsa LTCA Enid LTCA Project name, as...
    • 2012-09-25
    • Child abuse and neglect statistics, 2011/12

    • This statistical document for state fiscal year 2012 (July 1, 2011 through June 30, 2012) reflects data on child abuse and neglect reports received and accepted for investigation. Also included in this document is an alternative category of...
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    • Facts about the Sales Tax Relief Act

    • Facts about the Sales Tax Relief Act The Sales Tax Relief Act provides a $40 sales tax refund or credit for Oklahoma residents who lived in Oklahoma for the entire 2012 tax year if their yearly gross household income is within the limits described...
    • 2012-12-14
    • Telephone Interview Notice

    • Telephone Interview Notice Form 08AD093E v.2.1 11/01/2012 Page 1 of 2 Notice Information Date Case name Case # County # Supervisor # Worker # Before you receive or continue to receive benefits, you must be interviewed by telephone. Your interview...
    • 2012-12-14
    • Maximum Income, Resource, and Payment Standards

    • Maximum Income, Resource, and Payment Standards Schedule I.A - Categorically needy standards for: pregnant women [OAC 317:35-5-46]; persons under 19 years of age [OAC 317:35-5-45]; Temporary Assistance for Needy Families (TANF) continued medical...
    • 2012-12-14
    • Request for Background Check

    • Request for Background Check Form 04AD003E v.4 10/11/2012 Page 1 of 4 Print information clearly. Incomplete forms cannot be processed. Ensure a fax confirmation is received verifying that each page was successfully faxed. Part A. Applicant...
    • 2012-12-14
    • Client Contact and Information Request

    • Client Contact and Information Request Form 08AD092E v.4 11/01/2012 Page 1 of 3 Contact and Information Request Date Case name Case # County # Supervisor # Worker # You must respond to the items checked below before a decision is be made regarding...
    • 2012-12-14
    • Reasons for Negative Benefit Actions

    • Reasons for Negative Benefit Actions Section I. Financial Assistance tab (Section B), SNAP tab (Section C), Medical General tab (Section D), and computer messages for benefit closures, suspensions, or denials. Code reasons are in reason type rather...
    • 2012-12-14
    • Information for Benefit Renewal

    • Information for Benefit Renewal Form 08MP006E v.3 10/01/2012 Page 1 of 2 Benefit Renewal Requirements and Time Frames You must complete a benefit renewal every six months or annually if you receive food, health, or child care subsidy benefits. When...
    • 2012-12-14
    • Interview Notice

    • Interview Notice Form 08AD091E v.1 11/01/2012 Page 1 of 2 Notice Information Date Case name Case # County # Supervisor # Worker # Before you receive or continue to receive benefits, you must be interviewed. date time Telephone number we will use to...
    • 2012-12-14
    • Caregiver's Assessment of Child

    • Caregiver's Assessment of Child Form 04AN026E (DCFS-90) v.3 11/08/2012 Page 1 of 15 General Information Date completed Caregiver name Child's first name Last name Child's date of birth Foster parent Relative Other, specify: How long has the child...
    • 2012-12-14
    • Deadlines for Case Actions 2013

    • Deadlines for Case Actions 2013 I. Deadlines for processing actions requiring advance notice. When a negative action is taken and a computer-generated notice is issued that must give a 10 calendar day advance notice, for: · child care closure...
    • 2012-12-14
    • Proforma Invoice

    • Form 10CL220 (F-S-220) v.2 Page 1 of 1 Proforma Invoice 10/04/2012 Information Vendor name Social Security number Or Vendor FEI/EIN Receipt date Fund PO/Order type and number PA number Total amount Partial Final Vendor address City State ZIP...
    • 2012-12-14
    • Office of Client Advocacy - Intake Referral

    • Office of Client Advocacy - Intake Referral Form 15GN001E (OCA-1) v.1 09/27/2012 Page 1 of 9 Caller Information First name Middle name Last name Relationship Anonymous Other description Phone number Who Initially Disclosed the Incident? First name...
    • 2012-12-14
    • Bridge Resource Family Health History

    • Bridge Resource Parent Health History Form 04AF017E v.3 08/09/2012 Page 1 of 3 This form is used to obtain complete and accurate information regarding the prospective or current Bridge resource parent’s health history and is completed by the: (1)...
    • 2012-12-14
    • Request for Background Check

    • Request for Background Check Form 04AD003E 09/13/2012 Page 1 of 3 Print information clearly. Incomplete forms cannot be processed. Ensure a fax confirmation is received verifying that each page was successfully faxed. Part A. Applicant...
    • 2012-12-14
    • OK marriage minute, 11/14/2008

    • Helping Marriages Become Forever. For Real.; Dating and relationship skills offered to college students; Strengthening relationships from the Heart & Soul; Tulsa Initiative Seeks Partnership With OMI-Trained Workshop Leaders; Strong Response From...
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    • Request for Title XIX Nursing Assessment

    • *02AG001E-001* OKLAHOMADEPARTMENT OF HUMAN SERVICES Request for Title XIX Nursing Assessment Form 02AG001E is completed by the intermediate care facility (ICF) to notify OKDHS of a Medicaid client's admission into the ICF and request a nursing...
    • 2012-08-22
    • Older Americans Act Assessment, Part I

    • *02AG002E-001E* OKLAHOMADEPARTMENT OF HUMAN SERVICES Older Americans Act Assessment, Part I Initial date of contact Assessment *1Q2A1* Reassessment *1Q2A3* Date Source of referral to this office: Name Agency Agency case number Person providing...
    • 2012-08-22
    • Cash Disbursements Journal

    • Page number [Enter page number] Organi-zation name: [Enter organization name] Month and year [Enter month and year] Previous total [Enter previous totals] - - [Enter amount of check] [Enter...
    • 2012-08-22
    • OKDHS e-Release Submission Form

    • OKDHS e-Release Submission * Indicates Required Fields 16PR004E v.1 8-2-2012 Page 1 of 1 First name Last name City Email address Is this a media outlet? Yes No State County Complete this form to receive automatic notifications of OKDHS news...
    • 2012-08-17
    • Employee Identification ID Badge Request

    • Employee Identification (ID) Badge Request Form 23AM010E v.2 08/02/2012 Page 1 of 1 Badge Type Requested The division administrator must approve access to the PMO (Project Management Office) building. The division administrator must approve access...
    • 2012-08-17
    • Incident Report

    • Incident Report Form 06MP046E (DDS-46) v.3 08/02/2012 Page 1 of 3 Client Information Staff completes this form to report critical and non-critical incidents involving a person receiving Developmental Disabilities Services Division (DDSD)...
    • 2012-08-17
    • In-Home Supports Waiver -  Certificate of Competency

    • In-Home Supports Waiver 06IS037E (DDS-37) v.3 08/02/2012 Page 1 of 2 Certificate of Competency Name of habilitation training specialist (HTS)/direct support staff I want the above named person employed as HTS/direct support staff, and I certify the...
    • 2012-08-17
    • Cash Disbursements Journal

    • Page number: [Enter page number] Month and year of : [Enter month] Organi- zation name: [Enter organization name] Previous balance [Enter previous balance] Line number NSIP cash in lieu III-B...
    • 2012-08-22
    • Adult Day Service Invoice

    • STATE OF OKLAHOMA DEPARTMENT OF HUMAN SERVICES ADULT DAY SERVICE INVOICE Aging Services Division State Department No. 830 Date: IDENTIFYING INFORMATION: Fed. ID: Contract No.: Contractor: Address: Street-Box City State Zip Location PART I. CLAIMED...
    • 2012-08-22
    • Adult Day Services Monthly Report

    • Aging Services Division Adult Day Services Monthly Report Month of , 20 Name of center Total number of new Oklahoma Department of Human Services (OKDHS) participants approved: Name Case number Total number of OKDHS applications pending: Name Social...
    • 2012-08-22
    • Adult Day Services Referral/Application

    • Case number: County number: Adult Day Services Referral/Application A.Participant information: Name Date of birth Social Security number U.S. citizen Yes No If no, alien registration number Gender Male Female Race White American...
    • 2012-08-22
    • Annual Assessment

    • *02AG005E-001* OKLAHOMA'DEPARTMENT OF HUMAN SERVICES Aging Services Division Annual AssessmentArea Agency on Aging (AAA) Date completed 340:105-10-30. Designation of Area Agencies on Aging For an entity to be designated as an AAA, the agency's...
    • 2012-08-22
    • Voluntary Withdrawal of Title III Project

    • *02AG006E-001* OKLAHOMADEPARTMENT OF HUMAN SERVICES Voluntary Withdrawal of Title III Project When an Older Americans Act Title III funded project elects to voluntarily terminate a contract prior to the end of a grant year, procedures in paragraphs...
    • 2012-08-22
    • Equipment Inventory

    • STATE OF OKLAHOMA DEPARTMENT OF HUMAN SERVICES EQUIPMENT INVENTORY Project name Office/site location Fiscal year ended Funding Source QTY Item description Manufacture serial number Inventory ID. number Acquisition Cost Date Vendor/supplier This is...
    • 2012-08-22
    • Telephone Interview Notice

    • Telephone Interview Notice Form 08AD093E v.1 08/09/2012 Page 1 of 2 Notice Information Date Case name Case # County # Supervisor # Worker # Before you receive or continue to receive benefits, you must be interviewed by telephone. Your interview is...
    • 2012-08-24
    • Organization Financial Report

    • Organization Financial Report Adm. = Administrative Promo = Promotion Serv. = Services NSIP = YTD = Year to date A. Organization information AAA name Project name Address City Reported period Grant period Beginning Ending I certify that the...
    • 2012-08-22
    • Nutrition Project Attendance Form

    • *02AG016E-001* OKLAHOMADEPARTMENT OF HUMAN SERVICES Nutrition Project Attendance Form Date 20 Project name Site name: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35....
    • 2012-08-22
    • Records Check Documentation Form

    • Records Check Documentation Form Form 04AF007E (DCFS-109) v.3 08/09/2012 Page 1 of 7 Applicant Information Date of birth Social Security number First name Middle name Last name List other names used including maiden name, when...
    • 2012-08-24
    • In-Kind Travel Expense Voucher

    • *02AG014E-001* OKLAHOMA DEPARTMENT OF HUMAN SERVICES In-Kind Travel Expense Voucher Voucher number: for the month of , 20Traveler Purpose of travel Date From To Miles driven Total I certify that the above information is true and correct to the best...
    • 2012-08-22
    • Individual Attendance Record

    • STATE OF OKLAHOMA DEPARTMENT OF HUMAN SERVICES Project Site From 20 to 20 INDIVIDUAL ATTENDANCE RECORD Surname First Name Telephone Date of birth Address Race Sex DAY...
    • 2012-08-22

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