State Interstate Match Contact

State Interstate Match Contact

The State Interstate Match Contact is for states, Puerto Rico and the District of Columbia, to post contact information for interstate communication to assist in resolving matches. This is to augment the contact information already provided with each interstate match. In addition to being a resource to the PARIS community, the new State Interstate Match Contact page will lessen the calls made to the State Administrative Representatives currently listed on the PARIS website (www.acf.hhs.gov/programs/paris). Please complete and submit the following for updating the web page: State Interstate Match Contact - Form (doc 43.5KB)

NOTE: To access Puerto Rico or other territories, go to the bottom of the dropdown list. 

Alabama

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
X ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[ X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 2 Email, # 1 Phone, # 3 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: PIDPARIS@medicaid.alabama.gov
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
X ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

Program Support via Contact Point (check all that apply):
[ X ]  TANF (Temporary Assistance to Needy Families)

[ X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 2 Email, # 1 Phone, # 3 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
X ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

Alaska

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
[ X ]  TANF (Temporary Assistance to Needy Families)

X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[ X ]  GA (General Assistance)
X ]  SSI (Supplemental  Security Income)

[ X ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[ X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 2 Email, # 1 Phone, #3 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: tammy.teeter@alaska.gov
ii. Phone: 907-334-2388
iii. FAX: 907-334-2395

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

Program Support via Contact Point (check all that apply):
[ X ]  TANF (Temporary Assistance to Needy Families)

[ X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[ X ]  GA (General Assistance)
X ]  SSI (Supplemental  Security Income)

X ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 2 Email, # 1 Phone, #3 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: gina.kuntzman@alaska.gov
ii. Phone: 907-283-2952
iii. FAX: 907-283-2956

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

American Samoa

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

Arizona

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
X ]  TANF (Temporary Assistance to Needy Families)

X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 1 Email, # 2 Phone, #3 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: FAAPARISRequest@azdes.gov
ii. Phone: 602-542-8201
iii. FAX: 602-542-3585

B. Multiple contact points:
X ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #  FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

Arkansas

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
[ X ]  TANF (Temporary Assistance to Needy Families)

X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 1 Email, # 3 Phone, # 2 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
X ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:  First attempt contact to phone number or fax number in file

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #  FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

California

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 1 Email, #   Phone, # 2 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: PARIS@DHCS.CA.GOV

ii. Phone: ______
iii. FAX:  (916) 440-5233

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #  FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

Colorado

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
X ]  TANF (Temporary Assistance to Needy Families)

X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

X ]  GA (General Assistance)
X ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 2 Email, # 1 Phone, # 3 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[ X ]  Use contact data in match
[ ] Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #  FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

Commonwealth of the Northern Mariana Islands

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

Connecticut

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
X ]  TANF (Temporary Assistance to Needy Families)

X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, # 1  FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: 
ii. Phone: 

iii. FAX: 860-424-5333

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions: FAX only requests.

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

Delaware

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
X ]  TANF (Temporary Assistance to Needy Families)

X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

X ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

X ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 1 Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: DE_PARIS-ARMS@state.de.us

ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:    "Out-of-State Inquiry" in subject line, include your contact information. Include the names and date of birth for household members and their last 4 digits of SSN. List current address for household and date it was reported to your state. Expect an email  response within 5 business days.
 

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

District Of Columbia

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
X ]  TANF (Temporary Assistance to Needy Families)

X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

X ]  GA (General Assistance)
X ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 1 Email, # 3 Phone, # 2 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: hermena.kinard@dc.gov
ii. Phone: 202-535-1462
iii. FAX: 202-535-1455

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #  FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

Florida

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
X ]  TANF (Temporary Assistance to Needy Families)

X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

X ]  GA (General Assistance)
X ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

X ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 1 Email, # 2 Phone, # 3 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email:  D11_SFL_CallCenter@dcf.state.fl.us
ii. Phone: 866-762-2237
iii. FAX: 866-735-2469

B. Multiple contact points:
X ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

Georgia

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
X ]  TANF (Temporary Assistance to Needy Families)

X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 3 Email, # 2 Phone, # 1 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: advocate@dhr.state.ga.us
ii. Phone: 888-295-1769
iii. FAX: 404-463-0093

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

Guam

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

Hawaii

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
X ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 1 Email, # 3 Phone, # 2 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: eyamamoto@medicaid.dhs.state.hi.us
ii. Phone: (808) 692-8138
iii. FAX: (808) 692-8173

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

Idaho

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
X ]  TANF (Temporary Assistance to Needy Families)

X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
X ]  SSI (Supplemental  Security Income)

X ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 1 Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: welfraud@dhw.idaho.gov
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

Illinois

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
X ]  TANF (Temporary Assistance to Needy Families)

X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 1 Email, # 2 Phone, # 3 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: galen.wickline@illinois.gov
ii. Phone: 217-524-9665
iii. FAX: 217-524-9687

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

Indiana

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
X ]  TANF (Temporary Assistance to Needy Families)

X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 3 Email, # 1 Phone, # 2 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: deborah.emans@fssa.in.gov
ii. Phone: 574-935-0540
iii. FAX: 574-935-5021

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

Iowa

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
X ]  TANF (Temporary Assistance to Needy Families)

X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, # 1 Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: 1-877-855-0021
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: 1-877-855-0021
iii.FAX: ______

Special Instructions:  Need client zipcode to be routed
 

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

Kansas

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
X ]  TANF (Temporary Assistance to Needy Families)

X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

X ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 1 Email, # 2  Phone, # 3  FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: PARIS@dcf.ks.gov
ii. Phone: _(785) 296-3874 __
iii. FAX:   _(785) 296-6960___

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:  For PARIS inquiries sent via Fax, please specify "ATTN: PARIS TEAM" on the cover sheet.

Out of State inquiries not related to a PARIS match should be sent to: EBTMail@dcf.ks.gov

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
X ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
X ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions: Medical cases are administered by two state agencies, you must use the contact data provided on the match file to reach the appropriate KS contact for all medical PARIS matches.

 

Kentucky

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
X ]  TANF (Temporary Assistance to Needy Families)

X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 1 Email, # 3 Phone, # 2 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: CHFS.DFS.Claims@ky.gov
ii. Phone: (502) 564-3440
iii. FAX: (502) 564- 4021

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 1 Email, # 3 Phone, # 2 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: DFS.Medicaid@ky.gov
ii. Phone: (502) 564-3440
iii. FAX: (502) 564-4021

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

Louisiana

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
X ]  TANF (Temporary Assistance to Needy Families)

X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 1 Email, # 2 Phone, # 3 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: Cara.Shields@la.gov
ii. Phone: (225) 342-2342
iii. FAX:  (225) 342-9833

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 1 Email, # 2 Phone, # 3 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: susan.wright@la.gov 
ii. Phone:(985) 543-4331
 iii. FAX: (225) 376-4753

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

Maine

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
X ]  TANF (Temporary Assistance to Needy Families)

X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
X ]  SSI (Supplemental  Security Income)

X ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 1 Email, # 3 Phone, # 2 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: Paris@Maine.gov
ii. Phone: 207-287-2409 
iii. FAX: 207-287-5096

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

Maryland

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
X ]  TANF (Temporary Assistance to Needy Families)

X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

X ]  GA (General Assistance)
X ]  SSI (Supplemental  Security Income)

X ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 3 Email, # 2 Phone, # 1 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
X ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions: If you do not receive a response from the contact listed in the data match within 5 business days, contact Joyce Westbrook (410) 238-1299 or joyce.westbrook@maryland.gov

 

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

Massachusetts

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA& (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 2 Email, # 1 Phone, #3 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:  Donnie Costello
i. Email: ______
ii. Phone: (617) 847-3167_
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA& (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 2 Email, # 1 Phone, #3 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:  Jack Najjar
i. Email: ______
ii. Phone: _(617) 847-3173
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

Michigan

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
X ]  TANF (Temporary Assistance to Needy Families)

X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

X ]  GA (General Assistance)
X ]  SSI (Supplemental  Security Income)

X ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 1 Email, # 2 Phone, # 3 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: DHS-ICU-Customer-Service@michigan.gov
ii. Phone: 517-373-3908
iii. FAX: 517-335-6054

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

Minnesota

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
X ]  TANF (Temporary Assistance to Needy Families)

X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

X ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

X ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#  1 Email, # 3 Phone, # 2 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: paris.project.dhs@state.mn.us
ii. FAX: 651-431-7529
iii. Phone:  651-431-3010

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:  When contacting Minnesota, please put "PARIS Inquiry" in the subjsect line and provide the clients name, DOB and SSN.

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

Mississippi

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
X ]  TANF (Temporary Assistance to Needy Families)

X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 1 Email, # 3 Phone, # 2 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: EA.CustomerService@mdhs.ms.gov 
ii. Phone: 1-800-948-3050
iii. FAX: 601-359-4435

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:  First attempt contact to phone number or fax number in file

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

Missouri

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
X ]  TANF (Temporary Assistance to Needy Families)

X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

X ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

X ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 1 Email, # 2 Phone, # 3 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: Cole_Howerton.FSD_C&I@dss.mo.gov 
ii. Phone: 855-373-4636
iii. FAX: 573-522-6220

B. Multiple contact points:
X ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: Ask.MHD@dss.mo.gov 
ii. Phone: 573-751-3425
iii.FAX: 573-751-6564

Special Instructions:

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

Montana

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
X ]  TANF (Temporary Assistance to Needy Families)

X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 1 Email, # 2 Phone, # 3 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email:  hhsparis@mt.gov
ii. Phone: 406-444-4097
iii. FAX: 406-444-2547

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 1 Email, # 2 Phone, # 3 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: hhsparis@mt.gov
ii. Phone: 406-444-4097
iii. FAX: 406-444-2547

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

Nebraska

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
X ]  TANF (Temporary Assistance to Needy Families)

X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

X ]  GA (General Assistance)
X ]  SSI (Supplemental  Security Income)

X ]  CC (Child Care)

X ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 1 Email, # 3 Phone, # 2 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: DHHS.EconomicAssistancePolicyQuestions@nebraska.gov 
ii. Phone:  800-383-4278
iii. FAX:  402-471-9286

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

Nevada

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
X ]  TANF (Temporary Assistance to Needy Families)

X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, # 1 Phone, # 2 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone:702-486-1646
iii. FAX: 775-684-0844

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:  Faxed requests for coverage verification should be submitted on letterhead. 

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

New Hampshire

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
X ]  TANF (Temporary Assistance to Needy Families)

X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

X ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 1 Email, #   Phone, #  FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email:  bfarrell@dhhs.state.nh.us

ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

New Jersey

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
X ]  TANF (Temporary Assistance to Needy Families)

X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

X ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 1 Email, # 2 Phone, # 3 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: DFD.PAIU@dhs.state.nj.us
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
X ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:  Request must be from official government email address. No faxed request accepted. Include full name, DOB and the last 4 of SSN in your request.

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 1 Email, # 2 Phone, # 3 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: DFD.PAIU@dhs.state.nj.us
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
X ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:  Request must be from official government email address. No faxed request accepted. Include full name, DOB and the last 4 of SSN in your request.

 

New Mexico

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
X ]  TANF (Temporary Assistance to Needy Families)

X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

X ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 1 Email, # 2 Phone, # 3 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: HSDOIGFRAUD@state.nm.us
ii. Phone: 800-228-4802
iii. FAX: 505-827-8165

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

New York

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
X ]  TANF (Temporary Assistance to Needy Families)

X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, # 1 Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
XNYS contact list for PARIS 012014 Link to PDF as provided by the state; submit revised list to ACF

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

North Carolina

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
X ]  TANF (Temporary Assistance to Needy Families)

X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

X ]  GA (General Assistance)
X ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 2 Email, # 1 Phone, #3  FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
X ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:  Contact is county switchboard – ask to speak to interstate match worker.

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

North Dakota

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 1 Email, # 3 Phone, # 2 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: jhelbling@nd.gov

ii. Phone:701-328-1065
 iii. FAX: 701-328-5406
 

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

Program Support via Contact Point (check all that apply):
X ]  TANF (Temporary Assistance to Needy Families)

X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

X ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 3 Email, # 2 Phone, # 1 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: dhs.eap@nd.gov
ii. Phone: 701-328-2332
iii. FAX: 701-328-1060

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

Ohio

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
X ]  TANF (Temporary Assistance to Needy Families)

X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

X ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

X ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 1 Email, # 3 Phone, # 2 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
X ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

Oklahoma

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
X ]  TANF (Temporary Assistance to Needy Families)

X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

X ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 1 Email, # 3 Phone, # 2 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: OIG.PARIS@OKDHS.ORG
ii. Phone: 800-784-5887
iii. FAX: 405-522-4642

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:  Oklahoma Health Care Authority is secondary contact for on-line enrollment medical
 

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 1 Email, # 2 Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: eligibility@okhca.org
ii. Phone: 405-522-7084
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:  Cover PARIS matches for Oklahoma Medicaid Online enrollment only
 

 

Oregon

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
X ]  TANF (Temporary Assistance to Needy Families)

X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
X ]  SSI (Supplemental  Security Income)

X ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 1 Email, #   Phone, # 2 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
X ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: OR.Paris@state.or.us
ii. Phone: ______
iii.FAX:  503-378-3207

Special Instructions:

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

Pennsylvania

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
X ]  TANF (Temporary Assistance to Needy Families)

X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

X ]  GA (General Assistance)
X ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 2 Email, # 1 Phone, #3 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
X ]  PA PARIS County Contact List 06302014  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:  Match first two digits of record # with county on list.
 

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

Puerto Rico

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 1 Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: lecruz@salud.gov.pr
ii. Phone: 787-765-4074
 iii. FAX: 787-250-0990

 B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

Rhode Island

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
X ]  TANF (Temporary Assistance to Needy Families)

X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

X ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 1 Email, # 2 Phone, # 3 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: acalitri@dhs.ri.gov
ii. Phone:  401-462-6870
iii. FAX:  401-462-2975

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

South Carolina

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
X ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 2 Email, # 3 Phone, # 1 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: INTERFACES@SCDHHS.GOV
ii. Phone:  803-898-3020
iii. FAX:  803-255-8203

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

South Dakota

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
X ]  TANF (Temporary Assistance to Needy Families)

X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

X ]  GA (General Assistance)
X ]  SSI (Supplemental  Security Income)

X ]  CC (Child Care)

X ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 1 Email, # 2 Phone, # 3 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: vicki.vandenbos@state.sd.us
ii. Phone: 605-773-4678
iii. FAX: 605-773-7183

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

Tennessee

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
X ]  TANF (Temporary Assistance to Needy Families)

X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, # 2 Phone, # 1 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: 866-311-4287
iii. FAX: 615-687-5535

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email:  kimberly.hagan@tn.gov 
ii. Phone: ______
iii.FAX: 615-532-5236

Special Instructions:  FAX must be on your agency letterhead
 

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

Texas

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
X ]  TANF (Temporary Assistance to Needy Families)

X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
X ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, # 1 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: 1-877-447-2839

B. Multiple contact points:
X ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: 1-877-447-2839

Special Instructions:  Fax must be on your agency letterhead. Please submit one inquiry per page.
 

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

Utah

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
X ]  TANF (Temporary Assistance to Needy Families)

X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

X ]  GA (General Assistance)
X ]  SSI (Supplemental  Security Income)

X ]  CC (Child Care)

X ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, # 1 Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: 1-866-435-7414
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

Vermont

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
X ]  TANF (Temporary Assistance to Needy Families)

X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

X ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 2 Email, # 3 Phone, # 1 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email:  ahs-esd-paris@state.vt.us
ii. Phone: 802-769-6126
iii. FAX: 802-769-6048

B. Multiple contact points:
X ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

Virgin Islands

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

Virginia

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
X ]  TANF (Temporary Assistance to Needy Families)

X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 3 Email, # 1 Phone, # 2 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
X ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

Washington

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
X ]  TANF (Temporary Assistance to Needy Families)

X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

X ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

X ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, # 1 Phone, #2 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: 
ii. Phone: 1-855-927-2747 or 1-855-WAPARIS (TOLL-FREE-preferred method)
iii. FAX: 888-212-2319

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

West Virginia

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
X ]  TANF (Temporary Assistance to Needy Families)

X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

X ]  GA (General Assistance)
X ]  SSI (Supplemental  Security Income)

X ]  CC (Child Care)

X ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 1 Email, # 2 Phone, # 3 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:  (A-L Surnames)
i. Email:  tammy.w.hollandsworth@wv.gov
ii. Phone: 304-847-2861
iii. FAX: 304-847-7244
A. Single Point of Contact(M-Z Surnames)
i. Email:  rusty.b.udy@wv.gov
ii. Phone: 304-465-9613
iii. FAX:304-465-7288

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
#   Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: ______
ii. Phone: ______
iii. FAX: ______

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

Wisconsin

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
X ]  TANF (Temporary Assistance to Needy Families)

X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

X ]  GA (General Assistance)
X ]  SSI (Supplemental  Security Income)

X ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 1 Email, # 3 Phone, # 2 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: 
ii. Phone:
iii. FAX:

B. Multiple contact points:
[  ]  Use contact data in match
X PARIS Wisconsin Contact List Oct 2013 Link to PDF as provided by the state; submit revised list to ACF

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 1 Email, # 3 Phone, # 2 FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: 
ii. Phone:
iii. FAX:

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

 

Wyoming

Primary Contact Resource
Secondary Contact Resource
Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.

Program Support via Contact Point (check all that apply):
[  ]  TANF (Temporary Assistance to Needy Families)

[  ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

X ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 1 Email, #  Phone, #  FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email:  penny.davis@wyo.gov
ii. Phone: 307-777-3772
iii. FAX: 307-777-6964

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions:

Program Support via Contact Point (check all that apply):
X ]  TANF (Temporary Assistance to Needy Families)

X ]  SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps)

[  ]  GA (General Assistance)
[  ]  SSI (Supplemental  Security Income)

[  ]  CC (Child Care)

[  ]  WC (Workers’ Compensation)

[  ]  MA (Medical Assistance), Medicaid/Medical in most states

Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.)
# 1 Email, #   Phone, #   FAX

Contact Format used by State: (Answer for either A or B, but not both.)
A. Single Point of Contact:
i. Email: annette.jones@wyo.gov
ii. Phone: 307-777-5846
iii. FAX: 307-777-6276

B. Multiple contact points:
[  ]  Use contact data in match
[  ]  Link to PDF as provided by the state; submit revised list to ACF 

C. Contact for benefit redemption history/medical claims history if different from above:
i. Email: ______
ii. Phone: ______
iii.FAX: ______

Special Instructions: