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.

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ES = Spanish version available.

Title
Form 3016, Administrator Licensing - Reference for an Applicant
Form 3015, Application for a Child Care Administrator License or a Child-Placing Agency Administrator License
Form 3014, Administrator License – Renewal or Status Change
Form 3004, Family Foster Home Fire Safety Evaluation Checklist
Form 2997, Results of Public Hearing
Form 2986, Listing Permit Request ES
Form 2985, Affidavit for Applicants for Employment with a Licensed Operation or Registered Child-Care Home ES
Form 2982, Personal History Statement
Form 2974, Request for Risk Evaluation Based on Past Criminal History or Central Registry Findings
Form 2971, Child Care Regulation Request for Background Check ES
Form 2963, Admission of a Child from a Law Enforcement Officer
Form 2962, Verification of Liability Insurance
Form 2961, Request to Accept Children from Law Enforcement
Form 2954, Child Care Licensing Family Violence Calls Disclosure ES
Form 2948, Plan of Operation for Licensed Center and Home Operations