DHS Forms

The section below contains blank DHS Forms you can download, complete, and return when needed.
Type Language Action
DHS 1100B - INSTRUCTIONS English
DHS 1148 Instructions English
DHS 1148 - Medicaid Eligibility for Long-Term Care (LTC) Services English
DHS 1109 - Instructions English
DHS 1109 - Report of Self-Employment Earnings English
DHS1100B - SUPPLEMENTAL FORM FOR INDIVIDUALS APPLYING FOR COVERAGE ON A BASIS OTHER THAN MAGI AND-OR FOR THEIR REQUESTING LONG-TERM SERVICES English
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
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