Tdap 340 form baltimore city 2025

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The document is an Action Transmittal from the Family Investment Administration detailing new procedures for processing the Authorization for Reimbursement of Interim Assistance (DHR/FIA 340) form. It outlines changes in requirements for local departments regarding the completion and submission of the form, which is essential for obtaining reimbursement from the Social Security Administration for interim assistance payments made to individuals pending SSI claims or during benefit suspensions. The transmittal emphasizes adherence to a 30-day submission timeline and provides detailed instructions on filling out the form correctly.
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  1. Click ‘Get Form’ to open the tdap 340 form in the editor.
  2. Begin by entering your Local Jurisdiction name in the designated box. If applicable, specify your County and District Office name.
  3. Select either the INITIAL PAYMENT ONLY or POSTELIGIBILITY PAYMENT ONLY option based on your situation.
  4. Fill in your Customer ID Number and AU Number as shown in CARES.
  5. Indicate the Category by writing 'TDAP, DEAP/TCA' or 'PAA'.
  6. Provide your Social Security Number, Street Address, City or Town of residence, Zip Code, and Telephone number.
  7. Ensure both you and your Case Manager sign and date the form on the reverse side.
  8. Within two working days of signing, forward the original signed form along with required documentation to DEAP.

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Apply at your local department of social services office or through the Maryland Benefits web-portal. You may also file an application by mail, fax or other electronic means or someone may drop an application off for you.
Apply at your Local Department of Social Services in person. You may also file an application by mail, fax or other electronic means or someone may drop an application off for you.
An application for TDAP must be filed with your local Department of Social Services office in Baltimore. The review process normally takes about 30 days for a decision to be made and for notice sent to you of approval or denial of the request for benefits.

maryland tdap application pdf

Maryland TDAP 340 form 340 form baltimore County Maryland DHS 340 form Maryland TDAP application pdf TDAP application form Maryland Form 340 Maryland TDAP Form 500 Maryland TDAP application online

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Eligibility. You must: be unable to work for at least three months due to medical condition (a licensed medical practitioner must complete a medical report); and. have no children under 18 living with you.
AUTHORIZATION FOR REIMBURSEMENT OF INTERIM ASSISTANCE.

mydhr

Family Investment Administration - ACTION TRANSMITTAL

Upon receipt of the DHR/FIA 340 form, the case manager signs and dates the. 340 form and: 1. Enters the date the customer signed the 340 form in the IAR date

Learn more
TDAP 340 Form

The state can use this form for one case situation at a time, either an initial claim or a post-eligibility case. If both blocks are checked the form is not.

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