SFN 21, Transmittal Between Units 400-29-85-05

(Revised 9/00 ML #2584)

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This form is available through the Department of Human Services and may also be obtained electronically via E-Forms. (111kb pdf)

 

  1. County Eligibility Worker - The transmittal between units is used by the county eligibility staff to notify the Home and Community Based social worker of an action taken on a basic care applicant or recipient.

  1. Notification of approval, denial, or closure of a Basic Care Assistance Program applicant or recipient.
  2. Initial functional assessment needed or review of functional assessment due.
  3. Review due for Medicaid and Basic Care Assistance Program.
  4. A recipient moves from one basic care facility to another.

  1. The Home and Community Based Social Worker - The transmittal between units is used by the Home and Community Based social worker to notify the county eligibility worker of actions taken or the status of a recipient.

  1. Completion date of an initial or review of a functional assessment.
  2. A recipient moves from one basic care facility to another.