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| Family Support Services Division Forms |
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Below is a list of official forms for the OKDHS Family Support Services Division (FSSD). Some of the forms are not yet available online. You may contact the Human Services Center nearest you for a copy of the form.
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Request for Benefits and Services (Form 08MP001E) (.pdf, 4 pp, 41 KB)
Formerly known as PS-1, this document is used by OKDHS clients of the Family Support Services Division to file a request for benefits and services. This request form must be completed, signed and mailed or taken to the Human Services Center nearest you.
Request for Benefits and Services (Spanish version of Form 08MP003S) (.pdf, 4 pp, 21 KB)
Formerly known as PS-1SV, this document is used by OKDHS clients of the Family Support Services Division to file a request for benefits services. This request form must be completed, signed, and mailed or taken to the Human Services Center nearest you.
Low-Income Home Energy Assistance Application (Form 08LH002E ) (.pdf, 3 pp, 374 KB)
Formerly known as LIHEAP-1-B, this document is used clients to file a request for help to pay energy bills including electricity, natural gas, propane, butane, firewood, coal, oil or kerosene. This application form must be completed, signed and mailed or taken to the Human Services Center nearest you.
SoonerCare Health Benefits Application - SC-1 (.pdf, 5 pp, 689 KB) This form is used as an application for children, adults with children, or pregnant women who only want to apply for help with medical bills. This application form must be completed, signed, and mailed or taken to the Human Services Center nearest you.
SoonerCare Application (Spanish version of Form 08MA002S) (.pdf, 2 pp., 140 KB) Formerly know as SC-001-SV, this document is used as an application for children, adults with children, or pregnant women who only want to apply for help with medical bills. This application form must be completed, signed, and mailed or taken to the Human Services Center nearest you.
Child Care Eligibility/Rates Schedule OKDHS Appendix C-4 (.pdf, 8 pp, 1.3 MB)
This document is used by OKDHS clients to view the income eligibility and co-payment chart and explains how rates are paid. This document is also used by OKDHS contracted child care providers for viewing the amount OKDHS pays providers.
Child Care Eligibility/Rates Schedule (Spanish version of Appendix C-4) (.pdf, 8 pp, 65 KB)
This document is used by OKDHS clients to view the income eligibility and co-payment chart and explains how rates are paid. This document is also used by OKDHS contracted child care providers for viewing the amount OKDHS pays providers.
Health Insurance Portability and Accountability Act (Spanish version of Form 08HI001E) (.pdf, 2 pp, 53 KB)
This privacy notice tells how your health insurance information can be used by the OKDHS. This notice also explains how you can get access to your health information. |
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