This government document is issued by Division of Family and Children Services for use in Georgia
- Family And Children Services
This form is to be completed by the SSCM/JPPS for all foster care and adoption assistance applications forwarded to the appropriate Revenue Maximization Regional Office. The function of the form is to provide all necessary information for the Rev Max MES to determine financial eligibility in the removal home and is a part of the application for Medicaid and IV-E Foster Care and Adoption Assistance, Form 223.
Indicate on this form if the information provided is for the month of application or for a prior month’s MAO and indicate the month. If Medicaid is being requested for any of the three months prior to the application month, complete a separate Form 224 for the application month and for each month of retroactive MAO requested.