All Income Maintenance (IM) Forms and Worksheets

Below is a list of all Income Maintenance (IM) forms and worksheets.

When you are searching for a document, enter the number or a portion of the title in the search box below.

Assigned number	Title	Release date Sort ascending	File type	Language	Available to order
F-02260	Temporary QUEST Card Issuance Worker Checklist	12/2023	PDF	English	No
F-22571A	Caretaker Supplement (CTS) Instructions for Application	12/2023	PDF	English	No
F-22571	Caretaker Supplement Application	12/2023	PDF	English	No
F-22571AS	Caretaker Supplement (CTS) Instructions for Application, Spanish	12/2023	PDF	Spanish	No
F-16033	FoodShare Worksheet	10/2023	PDF	English	No
F-10114	Medicaid Disability Redetermination Report	10/2023	PDF	English	No
F-16076A	FoodShare Six-Month Report Instructions	10/2023	Word	English	No
F-16076AH	FoodShare Six-Month Report Instructions, Hmong	10/2023	Word	Hmong	No
F-16076AS	FoodShare Six-Month Report Instructions, Spanish	10/2023	Word	Spanish	No
F-16038SO	Administrative Disqualification Hearing Notice, Somali	08/2023	PDF	Somali	No
F-16038S	Administrative Disqualification Hearing Notice, Spanish	08/2023	PDF	Spanish	No
F-16038L	Administrative Disqualification Hearing Notice, Laotian	08/2023	PDF	Lao	No
F-16038G	Administrative Disqualification Hearing Notice, German	08/2023	PDF	German	No
F-16038H	Administrative Disqualification Hearing Notice, Hmong	08/2023	PDF	Hmong	No
F-16038CM	Administrative Disqualification Hearing Notice, Chinese (Simplified)	08/2023	PDF	Chinese (Simplified)	No
F-16038AR	Administrative Disqualification Hearing Notice, Arabic	08/2023	PDF	Arabic	No
F-16038	Administrative Disqualification Hearing Notice	08/2023	PDF	English	No
F-16038R	Administrative Disqualification Hearing Notice, Russian	08/2023	PDF	Russian	No
F-19002	Request to Reduce QUEST Card Balance	08/2023	PDF	English	No
F-16039SO	Waiver of Administrative Disqualification Hearing, Somali	07/2023	PDF	Somali	No
F-16039H	Waiver of Administrative Disqualification Hearing, Hmong	07/2023	PDF	Hmong	No
F-16039	Waiver of Administrative Disqualification Hearing	07/2023	PDF	English	No
F-16039AR	Waiver of Administrative Disqualification Hearing, Arabic	07/2023	PDF	Arabic	No
F-16039CM	Waiver of Administrative Disqualification Hearing, Chinese (Simplified)	07/2023	PDF	Chinese (Simplified)	No
F-16039S	Waiver of Administrative Disqualification Hearing, Spanish	07/2023	PDF	Spanish	No

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