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Ann Arbor Michigan Form 668-B: What You Should Know

B. Telephone: IHS (Information and Health Resources Administration) Address: 1115 N University Ave, Ann Arbor, MI 48106. Phone: (Pager) DFAE 1065 E. Grand River Ave, Suite 2-4, Saugatuck, MI 49440 Phone:. DFAE is the Hennepin County Department of Health & Human Services. It is the regional health care office for Hennepin County and serves as a medical care and social service agency for the people of Hennepin County. DFAE provides integrated services in six locations in Hennepin County and provides programs for the disabled, elderly, children and families, individuals with and without physical and mental disabilities, families of victims and abuse victims. The Department's goal is to improve community health, promote health within children and families, support individual and group self-help groups, foster self-sufficiency and strengthen the quality of life for individuals. The Hennepin County Department of Health and Human Services is a public health agency that promotes health through its community partnerships, community health initiatives, education programs and research. It was created as the county's first County-wide health services organization by the Legislature in 1968. RSA Form 5-100 — Family Member with an Intellectual Disability (5th Amendment for personal identification) Information Provided.  A. The applicant. B. The other individual's disability. C. The applicant's disability. D. The other individual's impairment(s), or lack thereof, if any. E. The manner of applying for the determination of disability by the Department. F. Identification of family member with mental or emotional difficulties. G. Certification in accordance with § 604.20. RSA Form 5-100 — Family Member with an Intellectual Disability Family member is described as: an individual who is mentally, developmentally, physically, or intellectually impaired (i.e., has a developmental, psychiatric, or intellectual disability). Family member(s) includes spouses, domestic partners, siblings, parents (including stepparent(s)) and relatives (e.g., grandparents).

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