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 H1242, Verification of Mineral Rights
Form H1242-FTI, Verification of Mineral Rights - FTI
Form H1245, Statement of Intent to Return to Home ES
Form H1246, Medicaid Eligibility Interview Guide
Form H1247, Notice of Delay in Certification ES
Form H1252, Designation of Burial Funds ES
Form H1256, Financial Management
Form H1259, Correction of Applied Income ES
Form H1260, Parental Status/Inheritances
Form H1263-A, Certification of Medical Necessity - Durable Medical Equipment or Other IME
Form H1263-B, Certification of No Medical Contraindication - Dental
Form H1272, Declaration of Resources
Form H1272-A, Spousal Impoverishment Assessment Letter
Form H1273, Request for Assessment Information
Form H1274, Medicaid Eligibility Resource Assessment Notification ES