Code of Maine Rules
10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES
144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL
Chapter 311 - WORK INCENTIVE (WIN) PROGRAM MANUAL
Chapter VI - APPENDIX

Universal Citation: 10 ME Code Rules ยง VI

Current through 2024-38, September 18, 2024

Note: For paper copies of these forms, contact the Department. Some could not be converted into electronic format for this version of Chapter 311.

Forms - Definitions

1. SWWN-002: Bill for Child Care Services

2. SWWN-026: WIN Registration Referral

3. SWWN-029: Notice to WIN/ES of AFDC Change

4. SWSS-083: Social Service Face Sheet

5. SWSS-085: Social Service Program Sheet

6. SWIM-017: Medical Statement Signed by Physician

7. G-16A: Purchase Authorization

8. G-31: Departmental Bill Head

9. ES-571-A: Waiver for Release of Information

10. ES-571-B: Employment Capacities Report Physical Status

11. ES-571-C: Employment Capacities Report Mental Status

12. MA-49: Request for Payment of Professional Services

13. MA 5-95: WIN Registration Record

14. MA 5-96: WIN Certification Record

15. MA 5-97: WIN Status Change Notice

16. SRS-NCSS-117, Part A: WIN Certifications Report

17. SRS-NCSS-117, Part B: AFDC WIN Grant Reductions Report

Disclaimer: These regulations may not be the most recent version. Maine may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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