The ReliaCard Visa is a payment option available to most DHHS clients and service providers. There is NO credit approval, NO existing bank account needed and NO minimum balance required. Receiving the card is simple with a four step process to complete the required form (FA-100-ES-C). (English and Spanish forms available.)
Check the "ReliaCard" box on the top of the form .
Complete all information in box #1.
Sign and date under Box #2.
Send it to DHHS at the address indicated on the form or fax it to (402) 471-7783.
You will receive your new ReliaCard within 10 days and after you activate it with a quick phone call, all future payments will be available to you on this card.
NOTE: Your current method of payment will remain the same until you receive and activate your card by establishing a Personal Identification Number (PIN).
If you are receiving multiple DHHS provider payments for services and programs like chore, respite, PAS or escort services, all will be paid or deposited on to one card.
You may obtain a second card for this account by calling Customer Service at (855-233-8382). U.S. Bank will charge a fee for this second card.
Individuals who receive payments from different state agencies such as provider payments, unemployment compensation or child support payments will receive a separate ReliaCard for each program. The cards are the same design, but are different colors for easy identification.
|DHHS Providers & Clients