Indiana
Protective Payee for Hoosier Works Card 49884
No One Left Outside provides source-based information. The issuing agency or plan decides eligibility, acceptance and availability.
Source / last checked DFR: Forms - 2026-11-02
- Form number
- 49884
DFR: Forms - Reviewed 2026-11-02
- What it is for
- Protective Payee for Hoosier Works Card 49884
DFR: Forms - Reviewed 2026-11-02
- Issuing agency
- Indiana Family and Social Services Administration (FSSA); this form appears in the DFR forms catalog.
DFR: Forms - Reviewed 2026-11-02
- Program
- TEMPORARY ASSISTANCE FOR NEEDY FAMILIES (TANF)
Protective Payee for Hoosier Works Card 49884 - Reviewed 2026-11-02
- Jurisdiction
- Indiana
DFR: Forms - Reviewed 2026-11-02
- Category
- TEMPORARY ASSISTANCE FOR NEEDY FAMILIES (TANF)
Protective Payee for Hoosier Works Card 49884 - Reviewed 2026-11-02
- Form type
- form
DFR: Forms - Reviewed 2026-11-02
- Who fills it out
- Recipient; TANF protective payee; authorized DFR representative.
Protective Payee for Hoosier Works Card 49884 - Reviewed 2026-11-02
- How to submit
- Not listed yet. Call to confirm.
- Documents to include
- Not listed yet. Call to confirm.
- Languages
- English
Protective Payee for Hoosier Works Card 49884 - Reviewed 2026-11-02
- Official page
- https://www.in.gov/fssa/dfr/forms-documents-and-tools/forms
DFR: Forms - Reviewed 2026-11-02
- Direct form link
- https://forms.in.gov/Download.aspx?id=8407
DFR: Forms - Reviewed 2026-11-02
- Revision date
- R3 / 4-11
Protective Payee for Hoosier Works Card 49884 - Reviewed 2026-11-02
- Signature
- Signature of recipient
Signature of TANF protective payee
Address of protective payee (number and street, city, state, and ZIP code)
Signature of authorized DFR representative
Protective Payee for Hoosier Works Card 49884 - Reviewed 2026-11-02
- Accessibility
- Not listed yet. Call to confirm.
- What the form says
All information must be completed and approved by the DFR before your Protective Payee can attend training and receive a Hoosier Works card.
Protective Payee for Hoosier Works Card 49884 - Reviewed 2026-11-02
Check the form number and revision before using it. Read the agency's privacy and consent terms before sharing personal information.