TX HHS Form 3035. Kidney Health Care Program Application
Form 3035 is the official application used to enroll in the Texas Kidney Health Care (KHC) Program. This program provides financial help and care coordination for Texans living with end-stage renal disease (ESRD).
TX HHS Form 8616. In-Home Individualized Skills and Socialization Service Delivery Log
Form 8616, updated in February 2023, is a weekly service delivery log used in the Texas Home and Community-Based Services (HCS) and Texas Home Living (TxHmL) programs.
TX HHS Form 3266. Licensed Chemical Dependency Counselor (LCDC) License Application
The LCDC License Application (Form 3266) is the final step for registered counselor interns in Texas who are ready to advance to full licensure.
TX HHS Form 2405. Affidavit for Risk Evaluation by Child Placing Agency
Form 2405 — Affidavit for Risk Evaluation by Child Placing Agency — is a mandatory document used in Texas when a foster or adoptive home includes (or plans to include) a person with a criminal history or a record in the Texas Central Registry.
TX HHS Form H1004. Cover Letter Authorized Representative Not Verified
Form H1004 is a notice sent by the Texas Health and Human Services Commission (HHSC) when someone submits a benefits application on behalf of another person and claims to be their authorized representative.
TX HHS Form H1857. Landlord Verification
Form H1857, also known as the Landlord Verification form, is a document used by Texas Health and Human Services (HHS) to confirm a client’s housing situation. Caseworkers rely on this form to verify details such as rent, utilities, household members, and the client’s payment history.
TX HHS Form 7240. Monthly Attendance Record
Form 7240 is a standardized Monthly Attendance Record used by child-care operations to document each child’s daily presence, absences, holidays, withdrawals, and other attendance-related details.
NYS DMV Form MV-902. Application for Duplicate Certificate of Title
The New York State MV-902 “Application for Duplicate Title” is the form used when the original Certificate of Title for a vehicle, boat, or manufactured home has been lost, destroyed, damaged, or becomes unreadable.
Form MV-9B. Personal Special Prestige License Plate Application
The Georgia MV-9B “Prestige License Plate Application” is the form vehicle owners use when they want a personalized (also called “prestige”) license plate for a personal vehicle or motorcycle.
CMS L564. Request for employment information
Form CMS L564/R297, approved by the Centers for Medicare & Medicaid Services (CMS), is an official Request for Employment Information. This form is primarily used to verify group health plan coverage when applying for Medicare during a Special Enrollment Period (SEP).