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 H1138, Living Arrangement Verification
Form H1137, Confirmation of Office Visit Work/School Excuse ES
Form H1136, Child Support Verification ES
Form H1135, Child Care Expense Verification ES
Form H1134, Help Statement Verification ES
Form H1122, Medicaid Action Notice ES
Form H1120, Medical Bills Transmittal ES
Form H1119, Medical Programs Income Worksheet
Form H1113, Application for Prior Medicaid Coverage ES
Form H1107, Request for Forced Change of Medical Coverage
Form H1106-A, Proofs You Need to Apply for a Social Security Number Card
Form H1106, Enumeration Referral ES
Form H1104, 90% Earned Income Deduction (EID) Eligibility and Tracking
Form H1102, TANF Worksheet for Special Reviews and Denials
Form H1101, TANF Worksheet