State Interstate Match Contact

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: ______
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 via PARIS@acf.hhs.gov

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 via PARIS@acf.hhs.gov

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

Special Instructions:

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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)
[ ] 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: Jamie.kaiser@alaska.gov
ii. Phone: 907-334-2390
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 via paris@acf.hhs.gov

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)
[ ] 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 via paris@acf.hhs.gov

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

Special Instructions:

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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: 602-364-2910
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 via paris@acf.hhs.gov

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 via paris@acf.hhs.gov

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

Special Instructions:

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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 via paris@acf.hhs.gov

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 via paris@acf.hhs.gov

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

Special Instructions:

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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 via paris@acf.hhs.gov

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 via paris@acf.hhs.gov

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

Special Instructions:

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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:
[ ] Use contact data in match
[ X ] paris_colorado_county_contact_list_revised_july_2012.pdf Link to PDF as provided by the state; submit revised list to ACF via paris@acf.hhs.gov

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 via paris@acf.hhs.gov

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

Special Instructions:

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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.)
# 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: charlene.darby@ct.gov
ii. Phone: 860-424-5280

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 via paris@acf.hhs.gov

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 via paris@acf.hhs.gov

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

Special Instructions:

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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 via paris@acf.hhs.gov

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.

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 via paris@acf.hhs.gov

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

Special Instructions:

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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 via paris@acf.hhs.gov

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 via paris@acf.hhs.gov

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

Special Instructions:

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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: Angela_carney@dcf.state.fl.us
ii. Phone: 850-487-8163
iii. FAX: 850-413-8735

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

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 via paris@acf.hhs.gov

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

Special Instructions:

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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 via paris@acf.hhs.gov

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 via paris@acf.hhs.gov

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

Special Instructions:

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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 via paris@acf.hhs.gov

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 via paris@acf.hhs.gov

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

Special Instructions:

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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 via paris@acf.hhs.gov

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 via paris@acf.hhs.gov

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

Special Instructions:

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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 via paris@acf.hhs.gov

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 via paris@acf.hhs.gov

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

Special Instructions:

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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 via paris@acf.hhs.gov

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 via paris@acf.hhs.gov

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

Special Instructions:

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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 via paris@acf.hhs.gov

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 via paris@acf.hhs.gov

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

Special Instructions:

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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) 
[ X ] 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, # Phone, # 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: ______
iii. FAX: ______

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

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

Special Instructions: Out-of-state inquiries that are not PARIS matches go 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 via paris@acf.hhs.gov

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

Special Instructions:

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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 via paris@acf.hhs.gov

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 via paris@acf.hhs.gov

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

Special Instructions:

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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 via paris@acf.hhs.gov

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 via paris@acf.hhs.gov

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

Special Instructions:

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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 via paris@acf.hhs.gov

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 via paris@acf.hhs.gov

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

Special Instructions:

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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 via paris@acf.hhs.gov

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 via paris@acf.hhs.gov

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

Special Instructions:

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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) 
[ ] 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
[ ] Link to PDF as provided by the state; submit revised list to ACF via paris@acf.hhs.gov

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.)
# 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
[ ] Link to PDF as provided by the state; submit revised list to ACF via paris@acf.hhs.gov

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

Special Instructions:

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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 via paris@acf.hhs.gov

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 via paris@acf.hhs.gov

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

Special Instructions:

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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.)
# 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: Renee.e.marquette@state.mn.us
ii. Phone: 651-431-3010
iii. FAX: 651-431-7529

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

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 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 via paris@acf.hhs.gov

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

Special Instructions:

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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