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This form is used for California residents who speak Tagalog and want to apply for the Qualified Low-Income Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and Qualifying Individuals (QI) programs.
This document is for individuals in Florida who want to change their name on their license or application for a license. It provides instructions on how to request a name change and the necessary supporting documentation.
This form is used for reactivating the license of an osteopathic physician in the state of Florida.
This type of document is used to request an exception in the Dual Enrollment Funding Program in Georgia due to extenuating circumstances.
This form is used for third-party attestation of the number of family members at recertification in North Carolina.
This form is used for residents in North Carolina to authorize certain actions or give permission in specific situations.
This form is used for requesting special authority to administer intravenous iron for the treatment of iron deficiency anemia in British Columbia, Canada.
This form is used for teaching institutions in North Carolina to apply for registration with the DHHS.
This type of document is used in Ontario, Canada for contesting an intention. It is written in French.
This form is used for authorizing the disclosure of protected information in the state of Kentucky.
This document is a Work Assignment Payment Agreement specific to the state of Kentucky. It outlines the terms and conditions for payment in a work assignment agreement.
This document outlines the code of conduct for work experience programs at reentry centers in Kentucky.
This form is used for applying for an exemption as an incorporated nonprofit ambulance service in the state of Maine.
This form is used for applying for an exemption for an incorporated nonprofit residential care facility or an incorporated nonprofit assisted housing program for the elderly in the state of Maine.
This Form is used for Charitable Suppliers of Medical Equipment in Maine to apply for an exemption.
This form is used for applying for an exemption as an incorporated nonprofit dental health center in the state of Maine.
This Form is used for nonprofit organizations or their affiliates in Maine that provide free clinical assistance to children with dyslexia to apply for exemption.
This form is used for nonprofit organizations in Maine that operate eye banks to apply for an exemption from certain taxes.
This form is used for filing an exemption application for an incorporated nonprofit hospice organization in the state of Maine.
This form is used for applying for exemption as an incorporated nonprofit home health care agency in the state of Maine.
This form is used for applying for exempt status for medical research institutions or educational television or radio stations in the state of Maine.
This form is used for applying for an exemption as an incorporated hospital in the state of Maine.