Forms

HHS forms are used every day to perform tasks such as applying for benefits, contracting to provide goods or services, reporting incidents, declaring end of life wishes, and conducting other business.

Title
Form 7255, Medication Authorization ES
Form 5873, Waiver and Community-based Programs and Services - Medicaid and CHIP Services Contract Application Packet Checklist
Form 3018, Administrator Licensing – Change in Contact Information
Form 3017, Child Care Regulation Request for Background Checks for an Administrator's License
Form 3016, Administrator Licensing Reference for an Applicant
Form 3015, Application for a Child Care Administrator License or a Child-Placing Agency Administrator License
Form 3014, Administrator License – Renewal or Status Change
Form 1583, Employee Qualification Requirements
Form 7271, Personnel Records Evaluation LCCH/RCCH
Form 7270, Children's Records Evaluation of a Licensed Child Care Home or Registered Child Care Home
Form 7263, Emergency Practices
Form 7261, Center Records Evaluation
Form 7260, Children's Records Evaluation of Child Care Centers
Form 7259, Personnel Records Evaluation – Child Care Centers
Form 7250, Staff Training Record