[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-305333-105":53,"doc-detail-305333-en":126},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":119,"head_meta":121,"extra_data":123,"updated_unix":125},105,"en","general-letter-no-6-ap-169-employees-manual-update-income-maintenance-programs-appendix","GENERAL LETTER NO. 6-AP-169 - Employees’ Manual Update - Income Maintenance Programs Appendix","","General Letter No. 6-AP-169 announces revisions to Iowa Medicaid’s Employees’ Manual, Title 6 Appendix, specifically the Income Maintenance Programs Appendix covering Contents 1-13, 2 and 3. The update renames and refreshes 470-0398 with new branding and vendor/agency name content, adds new form 470-0399 as a supplement, and revises 470-5771 and 470-5771(S) to reflect extended eligibility dates. Effective immediately and directs removal and destruction of specified superseded pages.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":41,"@type":70,"position":76},"https://docshare.wps.com/template/letters/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/general-letter-no-6-ap-169-employees-manual-update-income-maintenance-programs-appendix/305333/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/general-letter-no-6-ap-169-employees-manual-update-income-maintenance-programs-appendix/305333.png","ImageObject",442,249,{"name":88,"@type":89},"Connor ","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-02","2026-09-19",true,{"@type":98,"interactionType":99,"userInteractionCount":47},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What document section does General Letter No. 6-AP-169 revise?","Question",{"text":108,"@type":109},"It revises the Employees’ Manual, Title 6 Appendix, Income Maintenance Programs Appendix, covering Contents 1-13, 2 and 3.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"Which forms are updated or newly created in this revision?",{"text":113,"@type":109},"470-0398 is updated and renamed, 470-0399 is created as a new document supplement, and 470-5771 and 470-5771(S) are updated to reflect extended eligibility dates.",{"name":115,"@type":106,"acceptedAnswer":116},"What actions are required for the superseded material?",{"text":117,"@type":109},"Remove the specified pages from the Employees’ Manual, Title 6 Appendix, and destroy them, effective immediately.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},305333,1790441036,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":40,"category_name":41,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":47,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":30,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":139,"read_time":140},687207022233,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","October 11, 2024  \nGENERAL LETTER NO. 6-AP-169  \nISSUED BY: Bureau of Financial, Food, and Work Supports  \nDivision of Community Access and Eligibility  \nIowa Medicaid  \nSUBJECT: Employees’ Manual, Title 6 Appendix, Income Maintenance Programs Appendix, Contents 1-13, 2 and 3, revised; forms revised and new.  \nSummary  \nThis chapter is revised to  \n▪ Update and rename 470-0398, Accident or Injury Request for Information: First Request to reflect new branding and content regarding vendors and agency names  \n▪ Create 470-0399, Accident or Injury Request for Information: Final Notice as a new document to supplement 470-0398  \n▪ Update forms 470-5771 and 470-5771(S), Report of Stolen SNAP Benefits, to reflect extended eligibility dates  \nEffective Date  \nImmediately.  \nMaterial Superseded  \nRemove the following pages from Employees’ Manual, Title 6 Appendix, and destroy them:  \nPage  \nContents 1-13 2 and 3 470-0398  \n470-5771  \n470-5771(S)  \nDate  \nSeptember 27, 2024  \nSeptember 27, 2024 06/24  \n04/24  \n04/24  \nAdditional Information  \nRefer questions about this general letter to your area income maintenance administrator.  \nAbsent Parent Information, Form 470-3773 or 470-3773(S) ....................................... 1  \nAccident or Injury Request for Information: First Request, Form 470-0398 ............ 2  \nAccident or Injury Request for Information: Final Notice, Form 470-0399 ............... 3  \nAccount Transfer Error, Form 470-5437 ...................................................................... 4  \nAddendum to Application and Review Forms for Release of Information, Form 470-4670 or 470-4670(S) .......................................................................................... 5  \nAddendum to Application for Help with Medicare Prescription Drug Plan Costs, Form 470-4167 .......................................................................................................... 7  \nAdding an EBT Cardholder, Form 470-3983 or 470-3983(S) ...................................... 8  \nAdjustment to Overpayment Balance, Form 470-0010............................................. 10  \nAffidavit of Citizenship, Form 470-4373 or 470-4373(S) ........................................... 12  \nAffidavit of Identity, Form 470-4386 or 470-4386(S) ................................................. 13  \nAgreement for Automatic Deposit, Form 470-0261 or 470-0261(S) ......................... 14  \nAgreement for Telephone Hearing, Form 427-0415 or 427-0415(S) ........................ 15  \nAgreement to Pay a Debt, Form 470-0495 or 470-0495(S) ....................................... 16  \nAgreement to Sell Excess Property, Form 470-2909................................................ 17  \nAnnuity Release of Information, Form 470-4699 ...................................................... 19  \nAppeal and Request for Hearing, Form 470-0487 or 470-0487(S) ........................... 20  \nAppendix A for Health Coverage, Form 470-5433 or 470-5433(S) ........................... 23  \nApplication for COVID-19 Testing Coverage, Form 470-5618 or 470-5618(S) ........ 24  \nApplication for Extra Help with Medicare Prescription Drug Plan Costs, Form SSA-1020B-OCR-SM .............................................................................................. 25  \nApplication for Foster Care and Subsidized Adoption Medicaid, Form 470-5535 or 470-5535(S) ............................................................................................................. 26  \nApplication for Health Coverage and Help Paying Costs, Form 470-5170 or 470-5170(S) ............................................................................................................. 27  \nAsset Verification System (AVS) Payment Worksheet, Form 470-5498 ................. 29  \nAttribution of Resources Appeal Summary, Form 470-3144 ................................... 31  \nAuthorization for Examination and Claim for Payment, Form 470-0502 ................ 33  \nAuthorization for Release ","cbCaiaJw2JyW5KMl","https://ap.wps.com/l/cbCaiaJw2JyW5KMl","pdf",481417,"English","# Summary\n# Effective Date\n# Material Superseded\n# Additional Information\n## Form index (Absent Parent Information through Child Support Information Request)","[{\"question\":\"What document section does General Letter No. 6-AP-169 revise?\",\"answer\":\"It revises the Employees’ Manual, Title 6 Appendix, Income Maintenance Programs Appendix, covering Contents 1-13, 2 and 3.\"},{\"question\":\"Which forms are updated or newly created in this revision?\",\"answer\":\"470-0398 is updated and renamed, 470-0399 is created as a new document supplement, and 470-5771 and 470-5771(S) are updated to reflect extended eligibility dates.\"},{\"question\":\"What actions are required for the superseded material?\",\"answer\":\"Remove the specified pages from the Employees’ Manual, Title 6 Appendix, and destroy them, effective immediately.\"}]","GENERAL LETTER NO. 6-AP-169 - Employees’ Manual Update - Income Maintenance Programs Appendix | PDF",1789823853,6]