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.

ES = Spanish version available.

Title
Form 5201, Med-IT New Provider Request
Form 5200, Med-IT New User Request
Form 8001, Medicaid Estate Recovery Program Receipt Acknowledgement ES
Form 3213, Birthing Center License Renewal Addendum
Form SCR, Secondary Cardholder Request
Form 3212, Birthing Center License Application
Form 3912, Court Interpreter Certificate Renewal
Form 3960, Medical Interpreter Performance Test
Form 3919, Trilingual Interpreter Performance Tests
Form 3918, Test of Spanish Proficiency
Form 3905, Mentee Evaluation
Form 3904, Mentor Training Plan
Form 3903, Court Interpreter Mentor Application
Form 3924, Court Certificate Annual Renewal
Form 3901-3, Court Interpreter Performance Test