SFN 376, Drug-Related Felony/Fleeing Felon Review 400-19-165-175

(New 10/1/15 ML #3459)

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IM 5300

 

This form is used to determine if an individual is disqualified from participation in the TANF program due to Drug-Related Felony/Fleeing Felon Review.

 

This form is available through the Department of Human Services and may also be obtained electronically via E-Forms.

 

E-Forms are presented in Adobe Acrobat and require the Adobe Acrobat reader. If you do not currently have Adobe Acrobat reader installed, you may download a free copy by clicking the Get Adobe Reader icon below.