DHS Forms

The section below contains blank DHS Forms you can download, complete, and return when needed.
Type Language Action
DHS 1101 - ABSENT PARENT REFERRAL (ABPR) TO CHILD SUPPORT ENFORCEMENT AGENCY English
DHS 1161 - INSTRUCTIONS English
DHS 1163 - INSTRUCTIONS English
DHS 1167 - INSTRUCTIONS English
DHS 1125 - INSTRUCTIONS English
DHS 1125 - ASSIGNMENT OF PAYMENT, REPAYMENT AGREEMENT AND AUTHORIZATION AND WAIVER FOR RELEASE OF INFORMATION English
DHS 1167 - STATEMENT OF INTENT TO RETURN HOME (FOR INDIVIDUALS RECEIVING LONG-TERM CARE SERVICES IN A MEDICAL FACILITY, NURSING FACILITY OR IN THE COMMUNITY NOT IN THEIR OWN HOME) English
DHS 1128 - INSTRUCTIONS English
DHS 1123 - AUTHORIZATION TO DISCLOSE CONFIDENTIAL INFORMATION BY THE MED-QUEST DIVISION (MQD) English
DHS 1121 - DESIGNATE AUTHORIZED REPRESENTATION English
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