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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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Last Updated:  11/19/2009
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OKDHS Home > Library > Forms > Forms and Applications for Services
Library: Forms
OKDHS Forms
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Formas
307 forms found    Page 1  2  3  4  5  6  7   
View Form No.Results shown in ascending orderLegacy No.Form Name Category
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 Documentation of Training (.doc, 2 pp, 1.4 MB)Open Documentation of Training (.pdf, 2 pp, 268 KB)
07LC007E
OCC-007Documentation of TrainingChild 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 (.pdf, 1 pp, 25 KB)
07LC039E
OCC-039Child Care Staff Health RecordChild Care Licensing  
Open Staff Information - Child Care Facility (.doc, 2 pp, 629 KB)Open Staff Information - Child Care Facility (.pdf, 2 pp, 223 KB)
07LC041E
OCC-041Staff 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, 691 KB)Open Agency Certification Report (.pdf, 2 pp, 171 KB)
07LC047E
OCC-047Agency 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 Instructions (.pdf, 1 pp, 27 KB)
07LC057E
OCC-57Physical Plant Child Care Licensing  
Open Alternative Compliance Request (.doc, 1 pp, 693 KB)Open Alternative Compliance Request (.pdf, 1 pp, 143 KB)
07LC061E
OCC-061Alternative Compliance RequestChild Care Licensing  
Open Medication Permission (.doc, 2 pp, 787 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 Staff Information - Family Child Care Home (.doc, 2 pp, 631 KB)Open Staff Information - Family Child Care Home (.pdf, 2 pp, 226 KB)
07LC086E
N/AStaff Information - Family Child Care HomeChild 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, 4 pp, 715 KB)Open Criminal History Review Request (.pdf, 4 pp, 175 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 Instructions (.pdf, 2 pp, 23 KB)
08AD006E
ADM-123Certification for Special Needs Child Care Rate Child Care  
Open Employment Verification (.doc, 4 pp, 1.1 MB)Open Employment Verification (.pdf, 4 pp, 226KB)Open Employment Verification Instructions (.pdf, 1 pp, 13 KB)
08AD094E
ADM-094Employment VerificationMultiple Programs  
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, 259 KB)Open Changes in Household Circumstances (.pdf, 3 pp, 211 KB)Open Changes in Household Circumstances Instructions (.pdf, 1 pp, 12 KB)
08FB038E
FSP-38Changes in Household CircumstancesFood Stamps  
Open Food Stamp Rules (.doc, 2 pp, 474 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  
Open Low Income Home Energy Assistance Walk-In Application (.doc, 4 pp, 761 KB)Open Low Income Home Energy Assistance Walk-In Application (.pdf, 4 pp, 270 KB)Open Low Income Home Energy Assistance Walk-In Application Instructions (.pdf, 1 pp, 13 KB)
08LH002E
LIHEAP-001-BLow Income Home Energy Assistance Walk-In ApplicationApplications  
LIHEAP  
Open Presumptive Eligibility (PE) Budget Sheet (.doc, 4 pp, 693 KB)Open Presumptive Eligibility (PE) Budget Sheet (.pdf, 4 pp, 140 KB)
08MA003E
MA-PE-1Presumptive Eligibility (PE) Budget SheetApplications  
Medical  
Open Notification of Needed Medical Services (.doc, 3 pp, 609 KB)Open Notification of Needed Medical Services (.pdf, 3 pp, 154 KB)
08MA005E
MS-MA-5Notification of Needed Medical ServicesMedical  
Open Assessment of Assets (.doc, 3 pp, 899 KB)Open Assessment of Assets (.pdf, 3 pp, 186 KB)
08MA011E
MA-011Assessment of AssetsMedical  
Open Consent for Release of Information and Appointment of Representative (.doc, 3 pp, 782 KB)Open Consent for Release of Information and Appointment of Representative (.pdf, 3 pp, 171 KB)
08MA013E
N/AConsent for Release of Information and Appointment of RepresentativeMedical  
Open Reporting of Newborn Child of SoonerCare Member (.doc, 2 pp, 715 KB)Open Reporting of Newborn Child of SoonerCare Member (.pdf, 2 pp, 213 KB)
08MA015E
FSS-NB-001Reporting of Newborn Child of SoonerCare MemberMedical  
Open Authorization for Examination and Billing (.doc, 1 pp, 674 KB)Open Authorization for Examination and Billing (.pdf, 1 pp, 153 KB)Open Authorization for Examination and Billing Instructions (.pdf, 1 pp, 20 KB)
08MA016E
ABCDM-016Authorization for Examination and BillingMedical  
Open Notice to Pregnant Women Regarding Presumptive Eligibility for Medicaid (.doc, 1 pp, 839 KB)Open Notice to Pregnant Women Regarding Presumptive Eligibility (PE) for SoonerCare (Medicaid) (.pdf, 2 pp, 130 KB)
08MA020E
MA-PE-2Notice to Pregnant Women Regarding Presumptive Eligibility (PE) for SoonerCare (Medicaid)Medical  
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Street address: Oklahoma Department of Human Services
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