ScreeningNotice of Non-DiscriminationEligibilityConflict ofInterestFormFollow-UpFaxFormPowerAcctFormCHARITYGUIDEDeterminationof DisabilityRMI FormMartialStatusCERNERTaxHouseholdSizeHIPPlanSummaryIncomeIdentityAffidavit forChildrenUnder 16IndividualSolutionsHHWPlanSummaryARFFREE!WorkReleaseFormScreeningNotice of Non-DiscriminationEligibilityConflict ofInterestFormFollow-UpFaxFormPowerAcctFormCHARITYGUIDEDeterminationof DisabilityRMI FormMartialStatusCERNERTaxHouseholdSizeHIPPlanSummaryIncomeIdentityAffidavit forChildrenUnder 16IndividualSolutionsHHWPlanSummaryARFFREE!WorkReleaseForm

BINGO ELIGIBILITY - Call List

(Print) Use this randomly generated list as your call list when playing the game. There is no need to say the BINGO column name. Place some kind of mark (like an X, a checkmark, a dot, tally mark, etc) on each cell as you announce it, to keep track. You can also cut out each item, place them in a bag and pull words from the bag.


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  1. Screening
  2. Notice of Non-Discrimination
  3. Eligibility
  4. Conflict of Interest Form
  5. Follow-Up
  6. Fax Form
  7. Power Acct Form
  8. CHARITY GUIDE
  9. Determination of Disability RMI Form
  10. Martial Status
  11. CERNER
  12. Tax Household Size
  13. HIP Plan Summary
  14. Income
  15. Identity Affidavit for Children Under 16
  16. Individual Solutions
  17. HHW Plan Summary
  18. ARF
  19. FREE!
  20. Work Release Form