101-2           APPLICATION FORMS

101-2 A.      GEN 33 FORM

The Gen 33 application form is an initial Medicaid application used by Office of Children Services (OCS Office of Children's Services) staff for children in state-custody, Title IV-E foster care, and Title IV-E or state-only assisted adoptions.

101-2 B.     GEN 35 FORM

The Gen 35 application form is a specialized Medicaid application used by Department of Juvenile Justice youth corrections staff and Title IV-E caseworkers.

101-2 C.     GEN 50B FORM

The GEN 50B application form is an initial application for Alaska Temporary Assistance, Food Stamps, Adult Public Assistance, Medicaid, General Relief Assistance, and Chronic and Acute Medical Assistance.

101-2 D.     GEN 72 FORM

The Gen 72 application form is a review application for Alaska Temporary Assistance, Food Stamps, Adult Public Assistance, and Medicaid.

101-2 E.     GEN 75 FORM

The Gen 75 application form is a review application for Denali KidCare.

101-2 F.     GEN 132 FORM

The Gen 132 application form is an initial application for Denali KidCare.

101-2 G.     MED 4 FORM

The Med 4 application form is a Medicaid application for adults and children with long-term care needs who want to apply for nursing home, home and community-based services, disabled child living at home (TEFRA Tax Equity and Fiscal Responsibility Act) coverage, and for children applying for or receiving SSI Supplemental Security Income.