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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
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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 Guardianship, Advocacy, and Capacity Initial Review (.doc, 1 pp, 819 KB)Open Guardianship, Advocacy, and Capacity Initial Review (.pdf, 1 pp, 153 KB)
06MP033E
N/AGuardianship, Advocacy, and Capacity Initial ReviewDevelopmental Disabilities  
Open Guardianship, Advocacy, and Capacity Annual Review (.doc, 1 pp, 733 KB)Open Guardianship, Advocacy, and Capacity Annual Review (.pdf, 1 pp, 131 KB)
06MP034E
N/AGuardianship, Advocacy, and Capacity Annual ReviewDevelopmental Disabilities  
Open Incident Report (.doc, 2 pp, 204 KB)Open Incident Report (.pdf, 2 pp, 247 KB)
06MP046E
DDS-046Incident ReportDevelopmental Disabilities  
Open Employment Application Supplement (.doc, 1 pp, 720 KB)Open Employment Application Supplement (.pdf, 1 pp, 120 KB)
06PE039E
DDS-39Employment Application SupplementDevelopmental Disabilities  
Open Rights and Responsibilities of Community Services Worker in an Investigation of Maltreatment (.doc, 1 pp, 723 KB)Open Rights and Responsibilities of Community Services Worker in an Investigation of Maltreatment (.pdf, 1 pp, 120 KB)
06PE059E
DDS-59Rights and Responsibilities of Community Services Worker in an Investigation of MaltreatmentDevelopmental Disabilities  
Open Monthly Attendance Record (.doc, 3 pp, 1,471 KB)Open Monthly Attendance Record (.xls, 44 KB)
06WP044E
DDS-044Monthly Attendance RecordDevelopmental Disabilities  
Open Adult Day Services Progress Report (.doc, 5 pp, 172 KB)Open Adult Day Services Progress Report (.pdf, 5 pp, 144 KB)
06WP046E
N/AAdult Day Services Progress ReportDevelopmental Disabilities  
Open Exception Request for Waiver Employment Services (.doc, 2 pp, 683 KB)Open Exception Request for Waiver Employment Services (.pdf, 2 pp, 163 KB)
06WP047E
N/AException Request for Waiver Employment ServicesDevelopmental Disabilities  
Open Employment Progress Report (.doc, 2 pp, 1.2 MB)Open Employment Progress Report (.pdf, 2 pp, 181 KB)
06WP066E
DDS-066Employment Progress ReportDevelopmental Disabilities  
Open Staff Summary (.doc, 2 pp, 690 KB)Open Staff Summary (.pdf, 2 pp, 251 KB)
07LC002T
OCC-002Staff SummaryChild Care Licensing  
Open Transportation Information (.doc, 1 pp, 677 KB)Open Transportation Information (.pdf, 1 pp, 153 KB)Open Transportation Information Instructions (.pdf, 1 pp, 14 KB)
07LC005E
OCC-5Transportation InformationChild Care Licensing  
Open Equipment Inventory - Child Care Center (.doc, 13 pp, 1.4 MB)Open Equipment Inventory - Child Care Center (.pdf, 13 pp, 497 KB)
07LC006E
OCC-6Equipment Inventory - Child Care CenterChild Care Licensing  
Open Training Documentation (.doc, 2 pp, 1.4 MB)Open Training Documentation (.pdf, 2 pp, 268 KB)
07LC007E
OCC-7Training DocumentationChild Care Licensing  
Open Equipment Inventory - Part-Day Childrens Program (.doc, 5 pp, 645 KB)Open Equipment Inventory - Part Day Childrens Program (.pdf, 5 pp, 241 KB)Open Equipment Inventory - Part-Day Childrens Program Instructions (.pdf, 1 pp, 13 KB)
07LC020E
OCC-020Equipment Inventory - Part-Day Children's Program Child Care Licensing  
Open Comments and Recommendations Regarding Licensing Requirements (.doc, 1 pp, 1.0 MB)Open Comments and Recommendations Regarding Licensing Requirements (.pdf, 1 pp, 139 KB)
07LC021E
OCC-021Comments and Recommendations Regarding Licensing RequirementsChild Care Licensing  
Open Equipment Inventory - School Age Program (.doc, 3 pp, 621 KB)Open Equipment Inventory - School Age Program (.pdf, 3 pp, 215 KB)Open Equipment Inventory - School Age Program Instructions (.pdf, 1 pp, 13 KB)
07LC024E
OCC-24Equipment Inventory - School Age ProgramChild Care Licensing  
Open Request for Child Care Center Star Certification (.doc, 7 pp, 1.1 MB)Open Request for Child Care Center Star Certification (.pdf, 7 pp, 242 KB)
07LC025E
OCC-025Request for Child Care Center Star CertificationApplications  
Child Care Licensing  
Open Request for Family Child Care Home Star Certification (.doc, 5 pp, 852 KB)Open Request for Family Child Care Home Star Certification (.pdf, 5 pp, 194 KB)
07LC027E
OCC-027Request for Family Child Care Home Star CertificationApplications  
Child Care Licensing  
Open Notice to Comply (.doc, 2 pp, 859 KB)Open Notice to Comply (.pdf, 2 pp, 149 KB)
07LC037E
OCC-037Notice to ComplyChild Care Licensing  
Open Child Information (.doc, 2 pp, 1.3 MB)Open Child Information (.pdf, 2 pp, 179 KB)
07LC038E
OCC-038Child InformationChild Care Licensing  
Open Child Care Staff Health Record (.doc, 1 pp, 679 KB)Open Child Care Staff Health Record Instructions (.pdf, 1 pp, 24 KB)
07LC039E
OCC-39Child Care Staff Health Record Child Care Licensing  
Open Staff Information - Child Care Facility (.doc, 3 pp, 830 KB)Open Staff Information - Child Care Facility (.pdf, 3 pp, 223 KB)
07LC041E
OCC-41Staff Information - Child Care FacilityChild Care Licensing  
Open Child Placing Agency Compliance Review (.doc, 4 pp, 717 KB)Open Child Placing Agency Compliance Review (.pdf, 4 pp, 192 KB)
07LC043E
OCC-43Child Placing Agency Compliance ReviewChild Care Licensing  
Open Agency Certification Report (.doc, 2 pp, 771 KB)Open Agency Certification Report (.pdf, 2 pp, 145 KB)
07LC047E
OCC-47Agency Certification ReportChild Care Licensing  
Child Welfare  
Open Compliance Review - Residential Child Care Facility (.doc, 6 pp, 590 KB)Open Compliance Review - Residential Child Care Facility (.pdf, 6 pp, 230 KB)
07LC056E
OCC-56Compliance Review - Residential Child Care FacilityChild Care Licensing  
Open Physical Plant (.doc, 2 pp, 834 KB)Open Physical Plant (.pdf, 2 pp, 125 KB)Open Physical Plant Instructions (.pdf, 1 pp, 27 KB)
07LC057E
OCC-57Physical PlantChild Care Licensing  
Open Alternative Compliance Request (.doc, 1 pp, 731 KB)Open Alternative Compliance Request (.pdf, 1 pp, 129 KB)
07LC061E
OCC-61Alternative Compliance RequestChild Care Licensing  
Open Medication Permission (.doc, 2 pp, 787 KB)Open Medication Permission (.pdf, 2 pp, 211 KB)
07LC066E
OCC-66Medication PermissionChild Care Licensing  
Open Compliance Review for Child Care Centers (.doc, 11 pp, 419 KB)Open Compliance Review for Child Care Centers (.pdf, 11 pp, 429 KB)
07LC069E
OCC-069Compliance Review for Child Care CentersChild Care Licensing  
Open Fire Safety Inspection Report for Child Care (.doc, 3 pp, 773 KB)Open Fire Safety Inspection Report for Child Care (.pdf, 3 pp, 278 KB)
07LC070E
OCC-70Fire Safety Inspection Report for Child CareChild Care Licensing  
Open Compliance Review for School-Age Programs and Summer Day Camps (.doc, 9 pp, 780 KB)Open Compliance Review for School-Age Programs and Summer Day Camps (.pdf, 9 pp, 443 KB)
07LC072E
OCC-072Compliance Review for School-Age Programs and Summer Day CampsChild Care Licensing  
Open Compliance Review for Part-Day Childrens Programs (.doc, 9 pp, 892 KB)Open Compliance Review for Part-Day Childrens Programs (.pdf, 9 pp, 257 KB)
07LC073E
OCC-73Compliance Review for Part-Day Children's ProgramsChild Care Licensing  
Open Request for Extension of Time to Comply (.doc, 2 pp, 696 KB)Open Request for Extension of Time to Comply (.pdf, 2 pp, 201 KB)
07LC074E
OCC-74Request for Extension of Time to ComplyChild Care Licensing  
Open Child-Placing Agency - Record of Foster Home Closure (.doc, 1 pp, 657 KB)Open Child-Placing Agency - Record of Foster Home Closure (.pdf, 1 pp, 133 KB)
07LC078E
OCC-78Child-Placing Agency - Record of Foster Home ClosureChild Care Licensing  
Open Notice to Parents (.doc, 2 pp, 225 KB)Open Notice to Parents (.pdf, 2 pp, 216 KB)
07LC084E
N/ANotice to ParentsChild Care Licensing  
Open Child Care Waiver Request (.doc, 2 pp, 676 KB)Open Child Care Waiver Request (.pdf, 2 pp, 161 KB)
07LC089E
N/AChild Care Waiver RequestChild Care Licensing  
Open Waiver Reference (.doc, 2 pp, 681 KB)Open Waiver Reference (.pdf, 2 pp 156 KB)
07LC090E
N/AWaiver ReferenceChild Care Licensing  
Open Change of Ownership (.doc, 2 pp, 661 KB)Open Change of Ownership (.pdf, 2 pp, 65 KB)
07LC091E
N/AChange of OwnershipChild Care Licensing  
Open Insurance Verification (.doc, 1 pp, 670 KB)Open Insurance Verification (.pdf, 1 pp, 126 KB)
07LC092E
N/AInsurance VerificationChild Care Licensing  
Open Insurance Exception Notification (.doc, 1 pp, 661 KB)Open Insurance Exception Notification (.pdf, 1 pp, 122 KB)
07LC093E
N/AInsurance Exception NotificationChild Care Licensing  
Open Criminal History Review Request (.doc, 2 pp, 715 KB)Open Criminal History Review Request (.pdf, 2 pp, 152 KB)
07LC096E
N/ACriminal History Review RequestChild Care Licensing  
Open Certification for Special Needs Child Care Rate (.doc, 5 pp, 626 KB)Open Certification for Special Needs Child Care Rate (.pdf, 5 pp, 130 KB)Open Certification for Special Needs Child Care Rate Instructions (.pdf, 2 pp, 23 KB)
08AD006E
ADM-123Certification for Special Needs Child Care RateChild Care  
Open Application for Disaster Food Benefit Assistance (.doc, 1 pp, 167 KB)Open Application for Disaster Food Benefit Assistance (.pdf, 1 pp, 79 KB)
08FB030E
N/AApplication for Disaster Food Benefit AssistanceApplications  
Food Stamps  
Open Changes in Household Circumstances (.doc, 3 pp, 708 KB)Open Changes in Household Circumstances (.pdf, 3 pp, 174 KB)Open Changes in Household Circumstances Instructions (.pdf, 1 pp, 10 KB)
08FB038E
FSP-38Changes in Household CircumstancesFood Stamps  
Open Food Stamp Rules (.doc, 2 pp, 474 KB)Open Food Stamp Rules (.pdf, 2 pp, 32 KB)Open Food Stamp Rules Instructions (.doc, 1 pp, 311 KB)
08FB112E
FSP-112Food Stamp RulesFood Stamps  
Open Privacy Notice (.doc, 2 pp, 600 KB)Open Privacy Notice (.pdf, 2 pp, 56 KB)Open Privacy Notice Instructions (.pdf, 1 pp, 11 KB)
08HI001E
HIPAA-1Privacy Notice HIPAA  
Open Authorization to Disclose Medical Records (.doc, 2 pp, 177 KB)Open Authorization to Disclose Medical Records (.pdf, 2 pp, 152 KB)Open Authorization to Disclose Medical Records Instructions (.pdf, 1 pp, 12 KB)
08HI003E
HIPAA-003Authorization to Disclose Medical RecordsHIPAA  
Open Request for Accounting of Disclosures (.doc, 1 pp, 654 KB)Open Request for Accounting of Disclosures (.pdf, 1 pp, 134 KB)Open Request for Accounting of Disclosures Instructions (.pdf, 1 pp, 19 KB)
08HI004E
HIPAA-004Request for Accounting of DisclosuresHIPAA  
Open Request for Alternative Means of Communication (.doc, 1 pp, 657 KB)Open Request for Alternative Means of Communication (.pdf, 1 pp 68 KB)Open Request for Alternative Means of Communication Instructions (.pdf, 1 pp, 11 KB)
08HI006E
HIPAA-006Request for Alternative Means of CommunicationHIPAA  
Open Request for Amendment of Protected Health Information (.doc, 1 pp, 658 KB)Open Request for Amendment of Protected Health Information (.pdf, 1 pp, 132 KB)Open Request for Amendment of Protected Health Information Instructions (.pdf, 1 pp, 19 KB)
08HI007E
HIPAA-007Request for Amendment of Protected Health InformationHIPAA  
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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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