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.
Forms
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ES = Spanish version available.
| Title | Last updated |
|---|---|
| Form 1026, Verification of Railroad Retirement Benefits | November 23, 2021 |
| Form 1025, Request for Information Medicare Advantage Coordination | November 23, 2021 |
| Form 1023, Request for Services Funded by General Revenue | November 23, 2021 |
| Form 1020-V, Acknowledgement of Responsibility for Reporting Abuse, Neglect and Exploitation and Reasonable Suspicion of Crime | November 23, 2021 |
| Form 1020, Acknowledgement of Responsibility for Reporting Abuse, Neglect and Exploitation and Reasonable Suspicion of Crime | November 23, 2021 |
| Form 0702, Fax Cover Sheet for TxHmL and HCS | November 23, 2021 |
| Form 0067, Consent by Roommate for Authorized Electronic Monitoring ES | November 23, 2021 |
| Form 0066, Request for Authorized Electronic Monitoring | November 23, 2021 |
| Form 0065, Information Regarding Authorized Electronic Monitoring for Nursing Facilities ES | November 23, 2021 |