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Oklahoma Department of Human Services

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Oklahoma Department of Human Services
Sequoyah Memorial Office Building, 2400 N. Lincoln Blvd. • Oklahoma City, OK 73105
(405) 521-3646 • Fax (405) 521-6684 • Internet: www.okdhs.org
 
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Adult/Child Abuse and Neglect Hotline: 1-800-522-3511

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OKDHS Home > Library > Forms > Forms and Applications for Services
Library: Forms
OKDHS Forms
To view these forms, please choose the associated icon under the View column. In order to view the forms correctly, site guests may need additional software. In some cases, forms are saved as .pdf or .doc files. To take full advantage of the OKDHS content, get the latest versions of Adobe Acrobat Reader or Microsoft Word Viewer from the Downloads and Plug-ins page.
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316 forms found    Page 1  2  3  4  5  6  7   
View Form No.Results shown in ascending orderLegacy No.Form Name Category
Open Request for Child Abuse and Neglect Information System Search (.doc, 3 pp, 842 KB)Open Request for Child Abuse and Neglect Information System Search (.pdf, 3 pp, 202 KB)
04AN028E
DCFS-125Request for Child Abuse and Neglect Information System SearchChild Welfare  
Open Community-Based Residential Care (CBRC) Leave Tracking (.doc, 10 pp, 547 KB)Open Community-Based Residential Care (CBRC) Leave Tracking (.pdf, 5 pp, 42 KB)Open Community-Based Residential Care (CBRC) Leave Tracking Instructions (.pdf, 1 pp, 23 KB)
04CB001E
DCFS-126Community-Based Residential Care (CBRC) Leave TrackingChild Welfare  
Open CFSD Claim for Purchase of Residential Care (.doc, 1 pp, 54 KB)Open CFSD Claim for Purchase of Residential Care Instructions (.pdf, 1 pp, 29 KB)
04CB002E
DCYS-S-002CFSD Claim for Purchase of Residential Care Child Welfare  
Open Confidential Intermediary Statistical Information (.doc, 2 pp, 685 KB)Open Confidential Intermediary Statistical Information (.pdf, 2 pp, 177 KB)
04CI003E
DCFS-33Confidential Intermediary Statistical InformationChild Welfare  
Open Confidential Intermediary Results Report (.doc, 2 pp, 676 KB)Open Confidential Intermediary Results Report (.pdf, 2 pp, 136 KB)
04CI007E
DCFS-30Confidential Intermediary Results ReportChild Welfare  
Open Confidential Intermediary Certification Application (.doc, 4 pp, 744 KB)Open Confidential Intermediary Certification Application (.pdf, 4 pp, 195 KB)
04CI009E
DCFS-24Confidential Intermediary Certification ApplicationApplications  
Child Welfare  
Open Clothing Inventory (.doc, 1 pp, 702 KB)Open Clothing Inventory (.pdf, 1 pp, 138 KB)
04FC004E
DCFS-118Clothing InventoryChild Welfare  
Open Contact Log (.doc, 1 pp, 766 KB)Open Contact Log (.pdf, 1 pp, 145 KB)Open Contact Log Instructions (.pdf, 1 pp, 17 KB)
04FE001E
DCFS-EFC-10Contact LogChild Welfare  
Emergency Foster Care  
Open Personal Item Checklist (.doc, 2 pp, 682 KB)Open Personal Item Checklist (.pdf, 2 pp, 153 KB)Open Personal Item Checklist Instructions (.pdf, 1 pp, 12 KB)
04FE002E
DCFS-EFC-7Personal Item ChecklistChild Welfare  
Emergency Foster Care  
Open Request for Rate Increase (.doc, 1 pp, 692 KB)Open Request for Rate Increase (.pdf, 1 pp, 116 KB)Open Request for Rate Increase Instructions (.pdf, 1 pp, 18 KB)
04FE003E
DCFS-EFC-1Request for Rate IncreaseChild Welfare  
Emergency Foster Care  
Open AWOL Report (DCFS-EFC-2) (.doc, 1 pp, 698 KB)Open AWOL Report (DCFS-EFC-2) (.pdf, 1 pp, 131 KB)
04FE004E
04FE004EAWOL Report (DCFS-EFC-2)Child Welfare  
Emergency Foster Care  
Open School Report (.doc, 1 pp, 662 KB)Open School Report (.pdf, 1 pp, 129 KB)Open School Report Instructions (.pdf, 1 pp, 81 KB)
04FE005E
DCFS-EFC-8School ReportChild Welfare  
Emergency Foster Care  
Open Developmental Behavioral Checklist (.doc, 3 pp, 877 KB)Open Developmental Behavioral Checklist (.pdf, 2 pp. 220 KB)Open Developmental Behavioral Checklist Instructions (.pdf, 1 pp, 11 KB)
04FE006E
DCFS-EFC-9Developmental Behavioral ChecklistChild Welfare  
Emergency Foster Care  
Open Change of Emergency Foster Care Placement (.doc, 1 pp, 520 KB)Open Change of Emergency Foster Care Placement (.pdf, 1 pp, 139 KB)Open Change of Emergency Foster Care Placement Instructions (.pdf, 1 pp, 10 KB)
04FE007E
DCFS-EFC-4Change of Emergency Foster Care PlacementChild Welfare  
Emergency Foster Care  
Open Authorization for Hospital Discharge (.doc, 1pp, 653 KB)Open Authorization for Hospital Discharge (.pdf, 1 pp. 25 KB)Open Authorization for Hospital Discharge Instructions (.pdf, 1 pp, 18 KB)
04FE008E
DCFS-EFC-005Authorization for Hospital DischargeChild Welfare  
Emergency Foster Care  
Open Authorization for Foster Parent - Consent for Medical Services (.doc, 1 pp, 667 KB)Open Authorization for Foster Parent - Consent for Medical Services (.pdf, 1 pp, 158 KB)Open Authorization for Foster Parent - Consent for Medical Services Instructions (.pdf, 1 pp, 18 KB)
04FE009E
DCFS-EFC-12Authorization for Foster Parent - Consent for Medical ServicesChild Welfare  
Emergency Foster Care  
Open Appointment Log (.doc, 1 pp, 128 KB)Open Appointment Log Instructions (.pdf, 1 pp, 13 KB)
04FE010E
DCFS-EFC-6Appointment Log Child Welfare  
Emergency Foster Care  
Open Authorization for Foster Parent Consent for Medical Services - Emergency Custody (.doc, 1 pp, 663 KB)Open Authorization for Foster Parent Consent for Medical Services - Emergency Custody Instructions (.pdf, 1 pp, 12 KB)
04FE011E
DCFS-EFC-11Authorization for Foster Parent Consent for Medical Services - Emergency Custody Child Welfare  
Emergency Foster Care  
Open CFSD Claim for Purchase of Therapeutic Foster Care (.doc, 1 pp, 55 KB)Open CFSD Claim for Purchase of Therapeutic Foster Care Instructions (.pdf, 1 pp, 15 KB)
04FT001E
DCFS-128CFSD Claim for Purchase of Therapeutic Foster Care Child Welfare  
Open Leave Tracking (.doc, 1 pp, 670 KB)Open Leave Tracking (.pdf, 1 pp, 157 KB)Open Leave Tracking Instructions (.pdf, 1 pp, 18 KB)
04FT002E
DCFS-TFC-3Leave TrackingChild Welfare  
Open Request for Third Placement (.pdf, 5 pp, 39 KB)
04FT003E
DCFS-TFC-002Request for Third PlacementChild Welfare  
Open Notice of Childs Location (.pdf, 3 pp, 34 KB)
04FT004E
DCFS-TFC-001Notice of Child's LocationChild Welfare  
Open Out-of-State Placement Request Checklist (.doc, 2 pp, 662 KB)Open Out-of-State Placement Request Checklist (.pdf, 2 pp, 200 KB)
04IC006E
ICPC-107Out-of-State Placement Request ChecklistChild Welfare  
Open Financial/Medical Plan (.doc, 2 pp, 673 KB)Open Financial/Medical Plan (.pdf, 2 pp, 161 KB)
04IC012E
ICPC-104Financial/Medical PlanChild Welfare  
Open Independent Living Youth Exit Interview (.doc, 2 pp, 685 KB)Open Independent Living Youth Exit Interview Instructions (.pdf, 1 pp, 21 KB)
04IL003E
DCFS-087Independent Living Youth Exit Interview Child Welfare  
Open Request for Independent Living Youth Development Funds (.doc, 1 pp, 673 KB)Open Request for Independent Living Youth Development Funds (.pdf, 1 pp, 165 KB)Open Request for Independent Living Youth Development Funds Instructions (.pdf, 1 pp, 20 KB)
04IL006E
DCFS-84Request for Independent Living Youth Development FundsChild Welfare  
Open Request for Independent Living (IL) Service(s) - 18 to 21 (.doc, 1 pp, 671 KB)Open Request for Independent Living (IL) Service(s) - 18 to 21 (.pdf, 1 pp, 150 KB)Open Request for Independent Living (IL) Service(s) – 18 to 21 Instructions (.pdf, 1 pp, 18 KB)
04IL007E
DCFS-85Request for Independent Living (IL) Service(s) - 18 to 21Child Welfare  
Open Safety Assessment - Oklahoma Childrens Services (OCS) Version (.doc, 3 pp, 712 KB)Open Safety Assessment - Oklahoma Childrens Services (OCS) Version (.pdf, 3 pp, 263 KB)
04MP020E
DCFS-76-OCSSafety Assessment - Oklahoma Children's Services (OCS) VersionChild Welfare  
Open Referral for Contracted Services (.doc, 2 pp, 779 KB)Open Referral for Contracted Services (.pdf, 2 pp, 184 KB)
04MP032E
DCFS-108Referral for Contracted ServicesChild Welfare  
Open Child Welfare Referral for Substance Abuse Assessment and Treatment Services (.doc, 2 pp, 880 KB)Open Child Welfare Referral for Substance Abuse Assessment and Treatment Services (.pdf, 2 pp, 180 KB)
04MP033E
DCFS-98Child Welfare Referral for Substance Abuse Assessment and Treatment ServicesChild Welfare  
Open Application for Child Welfare Child Care Benefits (.doc, 6 pp, 1.1 MB)Open Application for Child Welfare Child Care Benefits (.pdf, 6 pp, 300 KB)
04MP042E
N/AApplication for Child Welfare Child Care BenefitsApplications  
Child Care  
Child Welfare  
Open State Funded Guardianship Assistance Agreement (.doc, 4 pp, 980 KB)Open State Funded Guardianship Assistance Agreement (.pdf, 4 pp, 150 KB)
04MP044E
N/AState Funded Guardianship Assistance AgreementChild Welfare  
Open Letter to Verify Tribal Membership of Resource Family Applicants (.doc, 1 pp, 668 KB)Open Letter to Verify Tribal Membership of Resource Family Applicants (.pdf, 1 pp, 139 KB)Open Letter to Verify Tribal Membership of Resource Family Applicants Instructions (.pdf, 1 pp, 17 KB)
04TB001E
DCFS-58Letter to Verify Tribal Membership of Resource Family ApplicantsChild Welfare  
Open Personal Computer Donation Request (.doc, 1 pp, 676 KB)Open Personal Computer Donation Request (.pdf, 1 pp, 130 KB)
05AD003E
N/APersonal Computer Donation RequestData Services  
General Use  
Open Certification Program Repayment Agreement (.doc, 1 pp, 509 KB)Open Certification Program Repayment Agreement (.pdf, 1 pp, 53 KB)
05EA001E
N/ACertification Program Repayment AgreementPersonnel  
Open Remote Access Request and Authorization (.doc, 1 pp, 678 KB)Open Remote Access Request and Authorization (.pdf, 1 pp, 161 KB)
05SC001E
DSD-2Remote Access Request and AuthorizationComputer Access  
Data Services  
General Use  
Open Decentralized Access Control Security Agreement (.doc, 1 pp, 670 KB)Open Decentralized Access Control Security Agreement (.pdf, 1 pp, 139 KB)Open Decentralized Access Control Security Agreement Instructions (.pdf, 1 pp, 17 KB)
05SC002E
DSD-3Decentralized Access Control Security AgreementData Services  
General Use  
Computer Access  
Open OKDHS Logon Authorization Request for OKDHS Employees (.doc, 2 pp, 706 KB)Open OKDHS Logon Authorization Request for OKDHS Employees (.pdf, 2 pp, 196 KB)Open OKDHS Logon Authorization Request Instructions (.pdf, 2 pp, 21 KB)
05SC003E
MID-1OKDHS Logon Authorization Request Computer Access  
General Use  
Open Logon Authorization Request for Non-OKDHS Employees (.doc, 2 pp, 694 KB)Open Logon Authorization Request for Non-OKDHS Employees (.pdf, 2 pp, 144 KB)Open Logon Authorization Request for Non-OKDHS Employees Instructions (.pdf, 1 pp, 11 KB)
05SC004E
MID-1-ALogon Authorization Request for Non-OKDHS EmployeesData Services  
General Use  
Computer Access  
Open Specialized Foster Care/Agency Companion Services Application (.doc, 2 pp, 574 KB)Open Specialized Foster Care/Agency Companion Services Application (.pdf, 2 pp, 191 KB)
06AC008E
DDS-8Specialized Foster Care/Agency Companion Services ApplicationDevelopmental Disabilities  
Open Site Visit Report (.doc, 1 pp, 656 KB)Open Site Visit Report (.pdf, 1 pp, 130 KB)
06CB035E
DDS-35Site Visit ReportDevelopmental Disabilities  
Open Monthly Summary of Restrictive/Intrusive Procedure Usage (.doc, 2 pp, 694 KB)Open Monthly Summary of Restrictive/Intrusive Procedure Usage (.pdf, 2 pp, 184 KB)
06CB055E
N/AMonthly Summary of Restrictive/Intrusive Procedure UsageDevelopmental Disabilities  
Open Residential Progress Report (.doc, 3 pp, 155 KB)Open Residential Progress Report (.pdf, 2 pp, 151 KB)
06CB062E
DDS-062Residential Progress ReportDevelopmental Disabilities  
Open Family Support Assistance Payment Services Application (.doc, 3 pp, 1318 KB)Open Family Support Assistance Payment Services Application (.pdf, 3 pp, 235 KB)
06DA031E
DDS-031Family Support Assistance Payment Services ApplicationApplications  
Developmental Disabilities  
Open Referral Form for Examination or Treatment (.doc, 1 pp, 688 KB)Open Referral Form for Examination or Treatment Instructions (.pdf, 1 pp, 25 KB)
06HM005E
DDS-5Referral Form for Examination or Treatment Developmental Disabilities  
Open Semi-annual Psychotropic Medication Review (.doc, 3 pp, 835 KB)Open Semi-annual Psychotropic Medication Review (.pdf, 3 pp, 154 KB)
06HM067E
DDS-67Semi-annual Psychotropic Medication ReviewDevelopmental Disabilities  
Open In-Home Supports Waiver - Certificate of Competency (.doc, 2 pp, 840 KB)Open In-Home Supports Waiver - Certificate of Competency (.pdf, 2 pp, 139 KB)
06IS037E
DDS-037In-Home Supports Waiver - Certificate of CompetencyDevelopmental Disabilities  
Open In-Home Supports Waiver - Family Members Statement (.doc, 2 pp, 662 KB)Open In-Home Supports Waiver - Family Members Statement (.pdf, 2 pp, 140 KB)
06IS038E
DDS-038In-Home Supports Waiver - Family Member's StatementDevelopmental Disabilities  
Open Request for Developmental Disabilities Services (.doc, 5 pp, 1.1 MB)Open Request for Developmental Disabilities Services (.pdf, 5 pp, 277 KB)
06MP001E
DDS-1Request for Developmental Disabilities ServicesApplications  
Developmental Disabilities  
Open Capacity Assessment (.doc, 1 pp, 1.2 MB)Open Capacity Assessment (.pdf, 17 pp, 641 KB)
06MP032E
N/ACapacity AssessmentDevelopmental Disabilities  
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Last Updated:  7/29/2010
Oklahoma Department of Human Services
Street address: Sequoyah Memorial Office Building, 2400 N. Lincoln Blvd., Oklahoma City, OK 73105
Mailing address: P.O. Box 25352, Oklahoma City, OK 73125
(405) 521-3646
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