DHS-1795A-ENG Interim Assistance Agreement

DHS-2630-ENG Alternative Care Program Eligibility Worksheet for Unmarried Individuals or Married Couples When Both May Choose the Alternative Care Program or a Married Person Whose Spouse Is an EW Recipient or Is Living in a Nursing Facility

DHS-2630A-ENG Alternative Care Program Eligibility Worksheet for a Married Person who has a Community Spouse

DHS-2825-ENG Notice of Contracted Per Diem Rates

DHS-3164-ENG Income withholding-only (Non-IV-D) services application for support order processing

DHS-3539-ENG Ryan White Annual Certification

DHS-3539A-ENG Ryan White Six-Month Recertification

DHS-3539B-ENG Ryan White New Applicant/Information Change

DHS-3539C-ENG Ryan White Verification of Employer Insurance

DHS-3539D-ENG Ryan White Healthcare Provider Request

DHS-3838-ENG Opioid Treatment Program Exemption Request and Record of Justification

DHS-3956-ENG Elderly Waiver Conversion Rate Request 

DHS-6381-ENG Residential or Inpatient Consolidated Chemical Dependency Treatment Fund (CCDTF) Service Change Request

DHS-6633A-ENG CDCS Community Support Plan Addendum with 2020-21 Budget Increase

DHS-6683-ENG Essential Community Supports Program (ECS) Financial Eligibility Worksheet

DHS-6683A-ENG Essential Community Supports Program (ECS) Eligibility Worksheet for a Married Individual when only one spouse is requesting services

DHS-7122-ENG Professional Statement of Need

DHS-7196-ENG CCAP Provider Registration Change Form

DHS-7313C-ENG Notification of Operation of Day Service Facilities

DHS-7313E-ENG Notification About Resuming Facility Operation for Adult Day Centers

DHS-7323-ENG 1115 Substance Use Disorder (SUD) System Reform Demonstration Project Provider Assurance Statement

DHS-7327-ENG Off Cycle Paid Claims Report Request

DHS-7329-ENG Individual Provider Affiliations

DHS-7335-ENG Adult Foster Care Minimum age variance request for a peacetime emergency 

DHS-7337-ENG Request for public data

DHS-7338-ENG Request for private data about yourself

DHS-7340-ENG Officer Involved Care-Coordination Assurance Statement – Counties

DHS-7846-ENG Extended Inpatient Psychiatric Services Provider Application

DHS-7982-ENG Notice to parents considering voluntary placement of their child co-located with them in a residential substance use disorder treatment program

DHS-7983-ENG Notice to parents or Indian custodians considering voluntary placement of their Indian child co-located with them in a residential substance use disorder program

DHS-7984-ENG Voluntary out-of-home placement agreement for child co-located with parent in residential treatment for substance use disorder

DHS-7985-ENG Voluntary out-of-home placement agreement for a child co-located with parent or Indian custodian in residential treatment for substance use disorder – Indian child