Dhs forms emergency contact
Web2. name and address of person to contact, if authorized representative is not available . specify relationship . telephone number ( ) 3. name and address of parent(s)/parent’s domestic partner, if known . telephone number ( ) 4. child’s court status (attach custody orders and agreements with parent(s), or person(s) having legal custody. note: WebEmergency Relief: Home, Utilities & Burial. Immediate help may be available if you are facing conditions of extreme hardship or emergencies threatening your health and safety. …
Dhs forms emergency contact
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WebThe form will make it easier to know exactly who you should notify in case of an accident or an emergency. The form allows personalized medical attention for the person who needs it. For instance, in a case where a … WebDHS-1514, Application for State Emergency Relief; DHS-1514-SP, Application for State Emergency Relief; DHS-1661, Insurance Assistance Program (IAP) DHS-3243, …
WebEmergency Contact Information. DHS 0902A (07.19) Adult foster home: Phone: Address: Resident’s name: Date of birth: Responsible party: Phone: Emergency contact: Phone: … WebEmergency Food Assistance; Consumer Education and Resources; ... 24 Hour Contact Information Form: PDF: 05/12/2024: DHS-4000 Release of Info Authorization – Spanish Edition: PDF: 05/11/2024: DHS-4000 Authorized to Disclose Health Info-Release of Info Form: PDF: 05/11/2024: DHS-8504 Start Service Form: PDF: 05/10/2024: DHS-8505 …
WebKristi Putnam. Kristi Putnam serves as the Arkansas Department of Human Services (DHS) Secretary. She is responsible for leadership and oversight of the department’s efforts, which support the health and well-being of all Arkansans, especially those who … WebJan 19, 2024 · New DSD Contact Form ready for use. DHS launched a new contact form for Disability Services Division (DSD) general inquiries. The DSD Contact Form provides a consistent way for people to submit questions and get technical assistance for DSD-related topics. For now, you can still send questions to and receive responses from a policy …
WebVital Records: Birth, Death, Marriage, and Divorce. The Division of Child Welfare Licensing receives and processes complaints for child caring institutions, child placing agencies, and juvenile court operated facilities. To make a complaint, complete the Division of Child Welfare Licensing’s Online Complaint Form.
WebOur Forms search page offers many options for finding current and past DHS forms. When using the search page: In the form number (Form #) field, use only numbers. Do not … software epson t1110WebOct 26, 2024 · Popular online forms and tips for services performed at DHS: Immigration forms, travel forms, customs forms, training forms, ... Contact Us. Employee … software epson stylus sx130WebHours of Operation. Our offices, located at 111 Westfall Road, Rochester, NY 14620 and 691 St. Paul Street, Rochester, NY 14605 are open between the hours of 8:00 AM to 4:00 PM. Walk-in applications are accepted Monday - Friday between these hours. DHS Limited English Proficiency Policy & Procedure. software epson scansmartWebemergency contact parental consent form 55 pa code chapters 3270.124(a)(b), 3270.181 & 182, 3280.124(a)(b), 3280.181 & 182, 3290.124(a)(b), 3290.181 & 182 ... medical or dietary information necessary in an emergency situation name name address telephone number when child is in care business name business name special disabilities (if any) ... slowest moving planetWeb51 rows · Mar 23, 2024 · Data Collection (Forms) Library. Forms produced by the Wisconsin Department of Health Services are available electronically and/or for paper … software epson stylus dx 4400WebSep 23, 2024 · To report suspicious activity, contact your local law enforcement agency or go to the National SAR Initiative. Any false information can subject the sender to fine, … software epson workforce pro wf c4810software epson xp 322 download