Americans with Disability Act: Request for Reasonable Modification
This is the same as the last section on page 3 but is specific to the authorized represenatative.
- Check yes if the authorized representative has a disability that will need reasonable accommodation.
- Choose one or more from the following
- Sign Language Interpreter
- TTY
- Large print
- Electronic communication (email)
- Braille
- Video relay
- Cued speech interpreter
- Oral interpreter
- Tactile interpreter
- Telephone reminder of program deadlines
- Telephonic signature
- Face-to-face interview (home visit)
- Check “one time” if the authorized representative only needs this as a service one time. Check ongoing if the assistance will be needed ongoing.
- If you can, explain when and for how long the authorized representative will need asisstance.
Express Lane Eligibility
This allows DFCS to renew your children’s Medicaid/Peachcare for Kids or add children to the Medicaid/Peachcare for Kids case if your family is already receiving Food Stamps or TANF using information from your Food Stamp or TANF review. This is helps streamline the process for you and the case manager.
Check yes if you are interested, no if you are not.
