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 H1265, Presumptive Eligibility (PE) Worksheet ES
Form H1266, Short-term Medicaid Notice – Approved ES
Form H1267, Short-term Medicaid Notice – Not Approved ES
Form H1550, Out of State NBCCEDP Verification
Form H1551, Treatment Verification ES
Form H1701, Child Support, TANF Foster Care and TANF/Medicaid Case Information Exchange
Form H1706, Good Cause Recommendation and Family Violence Exemption
Form H1708-A, Report of Noncooperation – Automated
Form H1710, Payment Identification ES
Form H1801, SNAP Worksheet
Form H1802, Voluntary Withdrawal from Temporary Assistance for Needy Families (TANF)
Form H1805, SNAP Food Benefits – Your Rights and Program Rules ES
Form H1806, Parole or Community Supervision Report ES
Form H1816, SNAP Employment and Training Noncompliance Report
Form H1817, SNAP Information Transmittal