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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 4009, Informed Consent for Pregnant Opioid/Opiate Use Disorder Individuals Seeking Treatment
Form 2856, Child Care Licensing Homebound Fingerprint Request
Form 4008, Informed Consent for Opiate Use Disorder Individuals Seeking Treatment – Youths Ages 13 to 18
Form 0009, Notice of Intent – County Jail Reporting
Form 3040, Review Findings and Plan of Improvement
Form 0007, Notification of County Jail Confinement and Release
Form 8003, Documentation of Transportation as Part of HCBS-AMH Service
Form 8002, Transportation Log
Form 3037,Good Faith Effort
Form 3025, Individual Safety Plan
Form 3024, Respite Relative Provider
Form 3005, Crisis Plan
Form 3007, Critical Incident Reporting
Form 3036, Preauthorization Request for Conversion Services
Form 3023, Notification of Participant Rights
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