Arkansas Department of Human Services Forms

This document is the OTC Synar Survey specific to the state of Arkansas. It is used to gather information about the sale and distribution of tobacco products to minors in retail establishments.

This form is used for vendors to apply for participation in the Arkansas Respite and Caregiver Conference in Arkansas.

This form is used for tracking the weekly attendance of children in Arkansas. It helps to maintain accurate records of child attendance for administrative and regulatory purposes.

This form is used for recording the daily attendance of children in the state of Arkansas. It helps ensure the safety and accountability of children in child care settings.

This Form is used for monitoring contact with targeted case management clients who receive Medicaid in Arkansas.

This Form is used for authorizing the release of confidential information from the Arkansas Child Maltreatment Central Registry. It is required to obtain access to records related to child maltreatment cases in Arkansas.

This Form is used for single adults in Arkansas to apply for health coverage.

This form is used for verifying earnings in the state of Arkansas.

This document is a daily log used to track staffing activities in Arkansas.

This document is used for assessing the emergency preparedness readiness of Long Term Care facilities in Arkansas, ensuring that they are equipped to handle emergencies and provide appropriate care to residents.

This form is used for applying as an independently licensed practitioner in Arkansas. It is the application form that individuals need to submit in order to obtain an independent license to practice in their chosen field.

This Form is used for applying for partial hospitalization certification in Arkansas.

This form is used for notifying the Arkansas authorities about the closing or relocation of a behavioral health agency site.

This form is used for applying for certification as a behavioral health agency in Arkansas. It is required to operate a behavioral health agency and provide services to individuals in the state.

This form is used for obtaining consent to release information from an accreditation organization in Arkansas.

This form is used for annual reporting by behavioral health agencies in Arkansas.

This Form is used for applying for a new site for a behavioral health agency in Arkansas.

This document is a petition to remove a neglect finding from the employment clearance registry for Certified Nursing Assistants (CNAs) in Arkansas.

This form is used for applying for the Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TEA) in Arkansas.

This form is used for applying for household health coverage in Arkansas.

This document is used for reporting or requesting a redetermination of eligibility for benefits in Arkansas.

This form is used to apply for child care assistance in the state of Arkansas. It helps low-income families access affordable and quality child care services.

This document provides information about the adoption process in the state of Arkansas. It includes details on eligibility criteria, requirements, and resources for prospective adoptive parents.

This document is for individuals or organizations applying to become certified as an alternative community service waiver provider in Arkansas.

This document is used for requesting an appeal hearing in Arkansas regarding certain matters.

This form is used for requesting a criminal record check in the state of Arkansas.

This document is for requesting a check of the Employment Clearance Registry in Arkansas. It is used to verify a person's employment history and ensure they do not have any disqualifying records.

This form is used for applying for a license to operate a long-term residential care facility, adult day care facility, adult day health care facility, or post-acute head injury facility in Arkansas.

This Form is used for applying as a homecare provider in Arkansas and making choices regarding homecare services.

This form is used for applying to become a targeted case management provider in Arkansas.

This Form is used for applying for a license to operate an Assisted Living Facility in the state of Arkansas.

This form is used for reporting incidents in the state of Arkansas. It is an attachment to Form DHS-1910 and allows individuals to provide details about an incident that occurred.

This document is a form used in Arkansas for the Money Follows the Person program. It is an informed consent form for individuals who wish to participate in the program.

This form is used for applying for a child care license or registration in the state of Arkansas.

This form is used to verify employment in Arkansas. It is issued by the Department of Homeland Security (DHS).

This Form is used for providing contact information to be reached round the clock in the state of Arkansas.

This form is used for communicating changes in client status for providers in Arkansas.

This Formulario DHS-4000 Autorizacion Para Proveer Informacion Medica - Arkansas is used for authorizing the release of medical information in the state of Arkansas.

This form is used for authorizing the disclosure of health information in the state of Arkansas. It allows individuals to give permission for their health information to be shared with specific individuals or organizations.