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Attached Document:
11ma022.pdf
OMM/OCFS/OTDA Materials: GIS Issued by OHIP
11 MA/022 - Revised "Notice of Decision on your Medicaid Application", OHIP-0053 (formerly DOH-4290)
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The purpose of this General Information System (GIS) message is to advise local departments of social services (LDSS) of revisions made to the DOH-4290, "Notice of Decision on your Medical Assistance Application." The Department form number of this document has been changed from DOH-4290 to OHIP-0053 (06/11). The DOH-4290 will be removed from the electronic Library of Official Documents (http://health.state.nyenet/revldssforms.htm) and will be replaced with the OHIP-0053.
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Created: 10/28/2011
Updated: 12/6/2011
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