SFN 640, Verification of Participation in Alternative Response for Substance Exposed Newborns 400-19-165-180

(Added 9/1/2021 ML #3629)

View Archives

 

SFN 640, Verification of Participation in Alternative Response for Substance Exposed Newborns (ARSEN)

 

The SFN 640, Verification of Participation in Alternative Response for Substance Exposed Newborns (ARSEN) form is used by the Human Service Zone Child Protection Service (CPS)/case manager when an applicant or recipient applying for TANF Incapacity Deprivation or requesting good cause from the JOBS Program based on participation in ARSEN.

 

The SFN 640 is provided by the Human Service Zone CPS/case manager to the eligibility worker who then saves the form to filenet.

 

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.