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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 8040, Federal Funding Accountability and Transparency Act (FFATA) Federal Awards Certification
Form 2419, Community Services Interest List (CSIL) Closure Communication
Form 1571, Request for Partial Reimbursement for the Cost Installation of a Fire Sprinkler System in a Four-Person Residence
Form 1142, PACE/SASO Registration Change
Form 6002, Autism Program Invoice
Form H1146, Medicaid Report
Form H1233, Case Review Notice
Form 2190, Capacity Assessment for Self-Care and Financial Management
Form 2072, Aggregate Report of OAA NSIP Eligible Meals
Form 6106, Private Psychiatric Hospital and Crisis Stabilization Unit Incident Report
Form 1357, Increlex Prior Authorization Request
Form 8628, Acknowledgement of Ombudsman Access to Confidential Record
Form 6110, Ambulatory Surgical Center Facility Incident Report
Form 6105, Hospital Facility Incident Report
Form 3503, Hearing Evaluation and Fitting and Dispensing Report
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