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 2604, STAR Kids Individual Service Plan – Service Tracking Tool ES
Form H1700-3, Individual Service Plan – Signature Page ES
Form 1701, Support Plan Narrative
Form 1028, Medically Fragile Group Criteria Certification
Form 2357, DFPS Records Check ES
Form 5202, Patient Navigation Consent ES
Form 1080, Health and Developmental Services (HDS) Promotion and Outreach Annual Plan
Form 1060, Health and Developmental Services (HDS) Promotion and Outreach Quarterly Report Promotion and Outreach Quarterly Report
Form 3202, Application to Operate or Close a Faith-Based Chemical Dependency Treatment
Form 3625, CLASS and CFC Documentation of Services Delivered ES
Form 3235, Licensed Chemical Dependency Counselor License Renewal Application
Form H1253, Verification of Health Insurance Policy
Form 3260, Licensed Chemical Dependency Counselor Intern Supervision Assessment
Form H1852, List of Resident Participants in the Supplemental Nutrition Assistance Program (SNAP) ES
Form 3203, Narcotic or Opioid Treatment Program Application