DHS Forms

The section below contains blank DHS Forms you can download, complete, and return when needed.
Type Language Action
DHS 1121A - AGREEMENT TO ACT AS AN AUTHORIZED REPRESENTATIVE English
DHS 1121A - INSTRUCTIONS English
DHS 8002 - REQUEST FOR A HARDSHIP WAIVER DUE TO THE TRANSFER OF ASSET PENALTY English
DHS 8002 - INSTRUCTIONS English
DHS 8004 - ANNUAL HOME EQUITY SURVEY FOR LONG-TERM CARE BENEFICIARIES English
DHS 8003 - INSTRUCTIONS English
DHS 8004 - INSTRUCTIONS English
DHS 8003 - REPORTING REQUIREMENTS FOR INDIVIDUALS REQUESTING RECEIVING COVERAGE OF LONG-TERM CARE SERVICES WITH ANNUITIES English
DHS 1179A - INSTRUCTIONS English
DHS 1169A - MAINTENANCE OF LIEN STATUS English
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