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 2987, Parent's Rights ES
Form 3960, Office of Deaf and Hard of Hearing Services (DHHS) – Medical Interpreter Performance Test
Form 3901-3, Office of Deaf and Hard of Hearing Services (DHHS) – Court Interpreter Performance Test
Form H0926, Sharing Facts About Me and My Case with a Community Partner ES
Form 1725, Consumer Directed Services – Criminal Conviction History and Registry Checks ES
Form 2276, Intake ES
Form 1016, PASRR Mental Illness Specialized Services Discussion Checklist
Form 3035, Kidney Health Care Program Application ES
Form 2362, Receipt Certification by a Qualified Rehabilitation Professional
Form H0404, Privacy Complaint ES
Form 3226, Freestanding Emergency Medical Care Facility License Application
Form 2551, Licensed and Registered Home: Caregivers, Assistants, Substitutes and Household Members Information Record
Form 2947, Child Care Center Personnel Information Record
Form 2937, Child Care Regulation Waiver or Variance Request
Form 0066, Request for Authorized Electronic Monitoring ES