Follow the steps to complete the MD DHS DHR/FIA 604-A form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the date and local district office details at the top of the form. This section ensures that your submission is directed to the appropriate office.
3. Fill in the case manager's name and telephone number, which facilitates communication regarding the processing of this form.
4. Provide the case name and case number/AU number, ensuring that the form is linked to the correct case.
5. Indicate whether the individual is a minor parent by selecting ‘YES’ or ‘NO’ within the designated box.
6. In Section I, enter the child's name, date of birth, and social security number. This information is crucial for identification purposes.
7. As the parent or guardian, sign below the authorization statement to permit the school to share attendance details with the Department of Social Services.
8. Proceed to Section II to be completed by a school official. Record the attendance details for the most recent marking period, including days enrolled and days absent.
9. Document the grade level and ensure the student's telephone number is filled in for further communication.
10. If applicable, complete the section regarding expected graduation dates, attendance for the most recently completed month, and if the parent/guardian is working to improve attendance.
11. Gather the contact information for the student’s parent/legal guardians, including names and work telephone numbers.
12. In Section III, the school official must sign and include their title, school name (which can use a school stamp), and telephone number.
13. Review all sections for accuracy before saving. You may download, print, or share your completed form as needed.

Complete your MD DHS DHR/FIA 604-A form online today for a smooth submission process.