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Arkansas Department of Human Services > DHS Forms  

DHS Forms

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APS-0001.docAPS-0001AASAPS-0001 Request for Adult Maltreatment Registry Information
Request for Adult Maltreatment Registry Information - MS Word document with some interactive form fields
NoNo1/1/2016
DCO-0152 Spanish.pdfDCO-0152 SpanishDCODCO-0152 Spanish
DCO-0152 Spanish, Application for Health Coverage ~ SOLICITUD DE COBERTURA DE SALUD
NoYes11/1/2015
DCO-0152.pdfDCO-0152DCODCO-0152
DCO-0152, Application for Health Coverage
NoNo11/1/2015
DCO-0777.pdfDCO-0777DCODHS-0777
DHS-0777, Long Term Care Medicaid Application for Assistance (with Voter Registration)
NoNo1/1/2016
DDS-5088.pdfDDS-5088DDSDDS-5088 Request for Criminal Background Check
DDS Specific Form - Request for Criminal Background Check
NoNo1/4/2016
DHS-0777 Spanish.pdfDHS-0777 SpanishDCODHS-0777
DHS-0777 Spanish, Long Term Care Medicaid Application for Assistance (with Voter Registration) ~ SOLICITUD PARA ASISTENCIA DE CUIDADO A LARGO PLAZO
YesYes1/1/2015
DHS-2808.docxDHS-2808DHSDHS-2808, Complaint of Employment Discrimination
DHS-2808 is to be completed by the person filing a discrimination complaint and should be submitted no more than 180 days from the date of the alleged action. MS Word document with online fillable form fields.
YesNo8/30/2011