max-height:500px; Retroactive Medicaid Application - DHS-3243. E-license - Renew Health Professional License Online! It may not include all of the relevant information on this topic. All applications and documents must be placed in an envelope provided at the service center. To view or print PDF files, you will need Adobe Acrobat Reader. Notification, Michigan Behavioral Risk Factor Surveillance System (MiBRFSS), Other Chronic Disease & Injury Control Data, Nondiscrimination Statement (No discriminación), apply for assistance is online using MI Bridges, Central Registry Clearance Request - DHS-1929, Participation Agreement For Michigan's Low Income Home Energy Assistance Program - DHS-355, Application for State Emergency Relief - DHS-1514, Application for State Emergency Relief - DHS-1514-SP, Insurance Assistance Program (IAP) - DHS-1661, Retroactive Medicaid Application - DHS-3243, Solicitud Para Medicaid Retroactivo - DHS-3243-SP, Medicaid Application Patient of Nursing Home - DHS-4574, Asset Declaration Patient and Spouse - DHS-4574-B, Declaration De Bienes Paciente Y Esposo/A - DHS-4574-B-SP, Voter Registration Application and Michigan Driver License/Personal Identification Card Address Change Form - NSP-0938-B, Solicitud de Registración del Votante y Licencia de Manejar de Michigan/Instrucciones de la Forma para Cambiar su Dirección en su Tarjeta de Identificación Personal - NSP-0938B-SP, Request for Medical Subsidy for An Adopted Child - DHS-1341-A, Adult Former Sibling Statement to Release Information to Adult Adoptee - DHS-1917, Release of Information to Adult Adoptee by Brother/Sister as proxy for Deceased Parent - DHS-1918, Parent's Consent/Denial to Release Information to Adult Adoptee - DHS-1919, Release of Information Authorization Adult Adoptee - DHS-1920, Request by Adult Adoptee for Identifying Information - DHS-1925, Adoption Facilitator Clearing House Record, DHS-4746, Bureau of Hospitals and Behavioral Health Administration, Service Animal Exclusion Assessment - MDHHS-5754, Service Animal Arrival Checklist - MDHHS-5755, Public Guardianship and Conservatorship Request for Reimbursement - MDHHS-5767, IV-D Child Support Services Application/Referral - DHS-1201, Office of Child Support Publication Order List - DHS-1454, Solicitud Para Servicios de Sostenimento de Ninos (IV-D)/Recomendacion - DHS-1201-SP, DHS-990 Relative Notification Letter (rev.2-19a), DHS-990-SP Relative Notification Letter (Spanish) (rev.2-19), DHS-990-AR Relative Notification Letter (Arabic) (rev.2-19), Report of Actual or Suspected Child Abuse or Neglect - DHS-3200, Report of Actual or Suspected Child Abuse or Neglect (Spanish) - DHS-3200-SP, Report of Actual or Suspected Child Abuse or Neglect (Arabic) - DHS-3200-AR, State of Michigan Sudden & Unexplained Child Death Scene Investigation Form, Earned Income Tax Credit Temporary Assistance for Needy Families (TANF) - DHS-3043, Asistencia Federal Temporal a Familias Necesitadas (TANF) Determinación de Elegibilidad - DHS-3043-SP, Solicitud Para Ayuda de Emergencia del Estado - DHS-1514-SP, Interstate Compact on Juveniles Petition for Requisition to Return a Runaway Juvenile - DHS-1908, Recommendation and Assurance for Pre-Adoption and Requirement Certification - DHS-3005, Interstate Compact on Juveniles Out of State Travel Permit and Agreement to Return - DHS-3034, Interstate Compact on Juveniles Requisition for Escapee/Absconder/Juvenile Charged Delinquent (Rendition Amendment) - DHS-3036, Interstate Compact on Juveniles Consent for Voluntary Return by Runaway, Escapee or Absconder - DHS-3037, Interstate Compact on Juveniles Parole or Probation Investigation Request - DHS-3038, Interstate Compact on Juveniles Parolee/Probationer Report to Receiving State - DHS-3039, Interstate Compact on Juveniles Application for Services and Waiver - DHS-3040, Sending State Priority Home Study Request - DHS-3750, Interstate Compact Placement Request - DHS-4332, Interstate Compact Report on Child's Placement Status - DHS-4333, Interstate Compact on the Placement of Children Placement Prescreening - DHS-4336, MDHHS-5849, Michigan ICPC Article III.c Supplemental Questions (COVID-19), Licensing - Adult Foster Care & Homes for the Aged, Adult Foster Care and Homes for the Aged rules and statues, Child Welfare Licensing Placement Assistance Request, CWL-4606, Disciplinary Action Unit Denial/Provisional/Revocation Checklist, CWL-4618, Variance Request for CPA/CCI/COF Rules - CWL-4006, Chief Administrator Annual Assessment and Corrective Action Plan (Public and Contract Child Placing Agency) - CWL-4607-CON, Independent Living Contract CPA Audit Workbook 8-17-18, TFC & ADO Contracts CPA Audit Workbook 8-30-18, PAFC & ADO Contracts CPA Audit Workbook 8-28-18, North American Indian Tribal Affiliation Verification - CWL-0120A, Court Operated Facility Rules Review Worksheets, Incident Accident Illness Death or Fire Report - CWL-4603, Criminal History Record Information Challenge or Correction Form (CWL 4614), Verification of Tribal Foster Home Safety Requirements - MDHHS-5612, Native American Affairs (NAA) and Native American Outreach Services (NAOS), American Indian/Alaska Native (AI/AN) Court Hearing Notification DHS-120, ICWA/MIFPA Multiple Document Mailing Cover Sheet DHS-120-A, Transfer To Tribal Agency/Court DHS-120-B, American Indian/Alaska Native Child Welfare Cultural Plan DHS-120-C, American Indian/Alaska Native Descendant Child Welfare Case Notification DHS-121-A, Indian Child Welfare Act Performance Checklist, Indian Outreach Services Referral IOS 382, Indian Outreach Services Contract Log IOS 383, Indian Outreach Services Packet Cover IOS 384, Indian Outreach Service Report Cover IOS 385, American Indian/Alaska Native Child Ancestry Verification MDHHS-5598, DHS-972 Relative Agreement for Placement and Licensure, DHS-3130-A, Children's Foster Care Relative Placement Home Study, MDHHS-5770, Relative Placement Safety Screen, Health Coverage & Help Paying Costs Application - DCH-1426, Reporting Changes When, How & What to Report - DHS-Pub-280, Reporting Changes When, How & What to Report (Spanish) - DHS-Pub-280-SP, MDHHS Can Help with Temporary Assistance - DHS Pub-783, Irrevocable Funeral Contract Certification - DHS-8-A, Authorization to Disclose Protected Health Information - DCH-1183, Certification of Translation for Non-English Speaking Applicants or Recipients - DHS-848, Voluntary Medical Background Form - DHS-4819, Forma Voluntaria de Antecedentes Medicos para un Recien Nacido Entregado - DHS-4819-SP, Voluntary Release for Adoption - DHS-4820, Entega Voluntaria Para Adopcion De Un Recien Nacido Por Parte De Un Padre - DHS-4820-SP, Volunteer Registration Record Ongoing Volunteers - DHS-1182-A, Volunteer Registration Record Short Term Volunteers - DHS-1182-B, Volunteer Registration Record Group Volunteers - DHS-1182-C, Request for Central Registry - DHS-1929 (Word), Nondiscrimination Statement(Declaración de No discriminación), Child Welfare Licensing Online Complaint Form, MI Bridges: Apply for Assistance & Manage Your Account, Birth, Death, Marriage, Divorce Certificates. View more information about DC Access here. Division of Aging, Adult, & Behavioral Health Services, Division of Child Care & Early Childhood Education, Division of Developmental Disabilities Services, Division of Provider Services & Quality Assurance, Office of Legislative and Intergovernmental Affairs, Meet the Chief Communications & Community Engagement Officer. If you need to use this paper application, keep in mind that you'll need to print and complete the application, and then take it to your local MDHHS office. A full list of business forms for businesses, employers, organisations, merchants and other professional clients and stakeholders. Payment Application for Nonregistered Providers 470-2890. The Michigan Department of Health and Human Services offers several medical assistance programs. DHS Forms.

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