SFN 640 Verification of Participation in Alternative Response for Substance Exposed Newborns (ARSEN) 400-28-165-90

(New 8/1/2023)

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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 Child Protective Service (CPS)/case manager when an applicant or recipient is applying for CCAP based on participation in ARSEN.

 

The SFN 640 is provided by the CPS/case manager to the eligibility worker who forwards the SFN 640 to State CCAP Policy.

 

This form is available through the Department of Health and 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.