2024年6月13日 · This form must be retained in the provider’s file ... MAD 295 Revised 06/13/2024

Regarding your Social Security Number, it is mandatory that you provide your Social Security Number(s) as required in 42 USC 405, or that you apply for a Social Security Number(s) with the Social Security Administration. This information will be used in eligibility determination and coordinating information with other public agencies.

DD Form 295 is intended to provide factual information that schools and other evaluating agencies require for evaluation of the applicant's educational achievement. By your signature, you verify that all information is accurate and taken directly from military records.

2022年12月29日 · The DD Form 295 allows veterans’ college credits from their military service to be evaluated and accepted by accredited colleges and universities. It helps ensure that veterans get maximum credit for their prior learning experience when they enroll in higher education institutions after leaving active duty.

DD FORM 295, APR 2000 Page 4 of 4 Pages

You may Fax this form to 334-353-5689, or Mail to: Alabama Medicaid Agency, Attn: Eligibility Change Unit, 501 Dexter Avenue, P O Box 5624, Montgomery, AL 36103-5624. You may also email the form to [email protected]

Paperwork Reduction Act Statement This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not …