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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 3910, Annual Certificate Renewal
Form 3909, Interpreter Performance Test Application
Form 3908, Test of English Proficiency
Form 6499, Application for Treatment
Form 1056, Case Transfer Letter
Form SSA-3288, Social Security Administration Consent for Release of Information
Form 3095, Home and Community-based Services Adult Mental Health (HCBS-AMH) Program Voluntary Referral Hold Request
Form H2340-OS, Medicaid for Breast and Cervical Cancer
Form H1869, Renewal for Health Care Benefits ES
Form H1842, SNAP-CAP Renewal Application ES
Form H1841, SNAP-CAP Application ES
Form H1019-F, Reporting Changes to Your Case ES
Form H1019, Report of Change ES
Form H1350, Opportunity to Register to Vote
Form 3273, General and Special Hospital License Designation Change Application
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