WebDHS-390 (Rev. 3-07) Previous edition may be used. MS Word 1 ADULT SERVICES APPLICATION FOR DEPARTMENTAL USE ONLY Michigan Department of Human Services 1. Case Name NOTE: If you need help to complete this application please indicate 2. Case Number 3. Recipient I.D. Number what kind of help you need WebFax this form to 616-977-1154 or 616-977-1158 Or email this form to [email protected] 1. Date – Enter the date the form is being completed. 2. List child (ren) suspected of being abused or neglected – Enter available information for the child (ren) believed to be abused or neglected.

CASE SERVICE PLANS - OVERVIEW, TYPES, AND …

WebIf you already have a MILogin account with a different system, you can log in using that information Webform used to preserve the application filing date for programs other than Medicaid, is available in the MDHHS-1171 and online at www.michigan.gov/dhs-forms. Note: A MI … fhh insurance

MI Bridges - Michigan

WebThese DHS titled forms are not to be completed or used with ACP cases: • DHS-4771-This form is for FICA withdrawal of funds from a provider check. FICA is not withheld from an ACP provider check. • DHS-4676-This form is a provider agreement between the client and their Home Help provider with the ILS program. The WebWelcome to MI Bridges Apply for Benefits, Manage Your Case, and Explore Resources. Login Apply for Benefits What Benefits are Available to You? You can apply for more than one … WebOrganizations in your community are ready to help you use MI Bridges. Receive One-on-One Assistance A Navigation Partner can guide you on using MI Bridges, Apply for Benefits, … f h hinsley