DHS-0029C-ENG Elderly, Disabled and Blind Income Computation Worksheet - Method B

DHS-3426-ENG OBRA Level I Criteria – Screening for Developmental Disabilities or Mental Illness

DHS-3535-ENG MHCP Individual Provider Profile Change

DHS-3535A-ENG MHCP Organization Provider Profile Change

DHS-3627-ENG Important information about your request for a Child Support Good Cause Exemption

DHS-3628-ENG Notice of denial of child support good cause exemption

DHS-3725-ENG EFT Supplier ID Notification

DHS-3751-ENG Individual Community Living Support (ICLS) - Planning Form

DHS-3767D-ENG Determination of Cost Effectiveness

DHS-3901-ENG MHCP Hardship Exemption Request

DHS-3903-ENG Alternative Payment Methodology Election for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs)

DHS-3918-ENG Late Request for Medicare Reimbursement

DHS-4005L-ENG Telephone Equipment Distribution Program Application

DHS-4145-ENG County Notice of IMD Status

DHS-4223-ENG Assignment of Payment for Day Training and Habilitation Services

DHS-4611A-ENG MHCP Individual Non-Pay-To Provider Agreement

DHS-4677H-ENG Application for changes to an ICF/D

DHS-5259-ENG Disclosure of Ownership and Control Interest of an Entity

DHS-5550-ENG Provider Entity Sale or Transfer Addendum

DHS-5590-ENG Medical Assistance for Long-Term Care (MA-LTC) Case Checklist

DHS-5716-ENG Individual DSW Information Change Request

DHS-5858-ENG Third Party Administrator Managed Care Organization (MCO) Setup

DHS-5937A-ENG Afghan Evacuees: Social Security Number Follow - up

DHS-6633B-ENG CDCS Enhanced Budget Request and Community Support Plan Addendum

DHS-6806-ENG Telehealth Provider Assurance Statement

DHS-6638-ENG Home and Community-Based Services (HCBS) Programs Service Request 

DHS-6855-ENG Designation of Billing Person for Home and Community-Based Services Waiver or Alternative Care

DHS-7117-ENG MHCP Yearly Income Statement

DHS-7120D-ENG Early Intensive Developmental and Behavioral Intervention (EIDBI) Level I Provider Assurance Statement

DHS-7192-ENG We Have Denied Your Health Plan Enrollment or Change Request

DHS-7645A-ENG EIDBI Benefit: Your rights and responsibilities

DHS-7645B-ENG EIDBI Benefit: Provider agency rights and responsibilities

DHS-8062-ENG Setting Capacity Report