| Assigned number | Title | Release date Sort ascending | Language | Available to order |
|---|---|---|---|---|
| F-10112A | Medicaid - Disability Application Addendum (PDF) | 11/05/2020 | English | No |
| F-10112AH | Medicaid - Disability Application Addendum, Hmong (PDF) | 11/05/2020 | Hmong | No |
| F-10112AS | Medicaid - Disability Application Addendum, Spanish (PDF) | 11/05/2020 | Spanish | No |
Last revised September 14, 2026