DHR-DHS Forms
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Product # Size Description Price
ABAWDS-1-2016 FLYER C ABLE BODIED ADULTS WITHOUT DEPENDENTS SNAP $0.00
CGVRGUIDCPSR12-14EN C CAREGIVER'S GUIDE TO CPS INVESTIGATION REV 12-14 ENG $0.00
CGVRGUIDCPSR12-14SP C CAREGIVER'S GUIDE TO CPS $0.00
CHLDINFOSTRCR12-14EN C WHEN YOUR CHILD IS PLACED IN FOSTER CARE REV 12-14 ENGLISH $0.00
CHLDINFOSTRCR12-14SP C WHEN YOUR CHILD IS PLACED IN FOSTER CARE REV 12-14 SPANISH $0.00
CITIZENSHIP AFFIDAVI C CITIZENSHIP AFFIDAVIT $0.00
DHR-197 REV 9-05 C TANF Sanction/Panel Review Guide $0.00
DHR-47 REV 2-09 C Food Stamp Program in Georgia - Booklet $0.00
DHR-523 REV 3-03 C Family Violence Option Assessment Report $0.00
DHS-1275 REV 2-19 C 8.5X11 VOTER REGISTRATION APPLCOVER LETTER REV 2-19 $0.00
DHS-1276 REV 5-12 C VOTER REGISTRATION DECLARATION STATEMENT $0.00
DHS-1277 C ST OF GA APP FOR VOTER REGISTRATION $0.00
DHS-138 REV 6-16 C NOTICE REQUIRE TO COOPERATE CHILD SUPPORT 8.5X11 2 SIDED $0.00
DHS-138SP REV 6-16 C SPANISH NOTICE REQ. COOPERATE CHILD SUPPORT 2 SIDED $0.00
DHS-139 REV 6-16 C CONTRIBUTION STATEMENT ENGLISH8.5X11 2PART NCR W/C $0.00
DHS-139SP REV 6-16 C CONTRIBUTION STATEMENT SPANISH8.5X11 2PART NCR W/C 2-SIDED $0.00
DHS-173 REV 6-10 C VERIFICATION CHECKLIST $0.00
DHS-173A REV 6-16 C APPOINTMENT LETTER 8.5X11 2PART NCR W/C $0.00
DHS-173ASP REV 6-16 C SPANISH APPOINTMENT LETTER 8.5X11 2PART NCR W/C $0.00
DHS-173SP REV 6-10 C VERIFICATION CHECKLIST (SP) $0.00
DHS-218 REV 1-14 C CITIZENSHIP/IDENTITY VERIFY CKLIST $0.00
DHS-218SP REV 1-14 C CITIZENSHIP/IDENTITY VERIFY CKLIST (SP) $0.00
DHS-219 REV 10-12 C AFFIDAVIT CITIZENSHIP $0.00
DHS-219SP REV 10-12 C AFFIDAVIT CITIZENSHIP (SP) $0.00
DHS-238 REV 8-11 C MEDICALLY NEEDY BUDGET SHEET $0.00
DHS-296 REV 10-20 C ENGLISH EXPEDITED FOOD STAMP SCREENING GUIDE 100/PK 8.5X11 $0.00
DHS-296SP REV 10-20 C SPANISH EXPEDITED FOOD STAMP SCREENING GUIDE 100/PK 8.5X11 $0.00
DHS-297 REV 9-20 C APPLICATION FOR BENEFITS 100/PK 16PG 50# WHITE TEXT 4/4 $0.00
DHS-297A REV 9-20 C RIGHTS & RESPONSIBILITIES 100/PK 16PG 50#TEXT 4/4 SADDLE $0.00
DHS-297A-SP REV 9-20 C SPANISH RIGHTS & RESPOSIBILITY100/PK 16PG 50# WH TXT 4/4 $0.00
DHS-297M REV 7-17 C MEDICAID ADDENDUM $0.00
DHS-297MSP REV 7-17 C MEDICAID ADDENDUM (SP) $0.00
DHS-297SP REV 9-20 C SPANISH APPLICATION FOR BEN. 100/PK 16PG 50# WH TXT 4/4 $0.00
DHS-298 REV 9-20 C SENIOR SNAP APPLICATION ENG. 100/PK 8PG 50# WHITE TEXT 4/4 $0.00
DHS-298SP REV 9-20 C SPANISH SENIOR SNAP APP. 100/PK 8.5X11 8PAGE SADDLE ST. $0.00
DHS-299 REV 2019 C SENIOR SNAP BROCHURE 8.5X11 TRI-FOLD 80# GLOSS TEXT $0.00
DHS-299SP REV 2019 C SENIOR SNAP BROCHURE SPANISH 8.5X11 TRI-FOLD 80# GLOSS TEXT $0.00
DHS-47SP REV 11-12 C FOOD STAMP PROGRAM IN GA (SP) $7.40
DHS-505 REV 1-16 C TANF ADA COMPLIANCE CHECKLIST $0.00
DHS-508 REV 9-20 C FOOD STAMP/ MEDICAID/ TANF RENEWAL 100/PK 20PG SADDLE $0.00
DHS-508SP REV 9-20 C FOOD STAMP/ MEDICAID/ TANF SPANISH RENEWAL FORM $0.00
DHS-521 REV 7-18 C OFI SERVICES BROCHURE $0.00
DHS-521SP REV 7-18 C SPANISH OFI SERVICES BROCHURE $0.00
DHS-522 REV 2-13 C WHAT EVERY WOMAN NEEDS TO KNOW BROCHURE $0.00
DHS-522SP REV 2-13 C WHAT EVERY WOMAN NEEDS TO KNOW BROCHURE (SP) $0.00
DHS-524 REV 11-15 C TEMPORARY ASSIST FOR NEEDY FAMILIES $0.00
DHS-524SP REV 11-15 C TEMPORARY ASSIST FOR NEEDY FAMILIES $0.00
DHS-5459 REV 7-16 C AUTHORIZATION FOR RELEASE OF INFORMATION 8.5X11 50# WHITE $0.00
DHS-5460 REV 4-16 C HIPAA FORM ENGLISH $0.00
DHS-5460SP REV 4-16 C HIPAA FORM SPANISH $0.00
DHS-5667 REV 2-11 C HEAD OF HOUSEHOLD INFORMATION $0.00
DHS-6000 REV 8-17 C APPLICATION FOR ENERGY ASSISTANCE $0.00
DHS-6000A REV 2-19 C LIHEAP COOLING APPL ENERGY ASSIST (BLUE/ CANARY/ PINK) $0.00
DHS-6003 REV 11-10 C EAP INCOME WORKSHEET RENT VERIFICATION $0.00
DHS-6004 REV 1-17 C LOW INCOME HOME EAP INFORMATION NOTICE $0.00
DHS-6005 REV 10-11 C REGULATED NATURAL GAS PROVIDER REFERRAL $0.00
DHS-6009 REV 11-10 C EAP VERIFICATION CHECKLIST $0.00
DHS-6019 REV 11-10 C EAP BATCH HEADER $0.00
DHS-6020 REV 11-10 C ERROR CORRECTION FORM $0.00
DHS-6021 REV 11-10 C EAP - DECLARATION OF ZERO INCOME $0.00
DHS-6022 REV 10-17 C LIHEAP AUTHORIZATION FOR REL OF GENERAL CONFIDENTIAL $0.00
DHS-700 REV 5-11 C Q-TRACK APPLICATION $0.00
DHS-700SP REV 5-11 C Q-TRACK APPLICATION (SP) $0.00
DHS-701 REV 10-12 C Q-TRACK BROCHURE $0.00
DHS-823 REV 2-16 C ABAWD WORK REQUIREMENTS WHAT YOU NEED TO KNOW $0.00
DHS-831 REV 2018 C TEFAP- EMERGENCY FOOD ASSISTANCE PROGRAM BROCHURE $0.00
DHS-854 REV 7/17 C GA DISASTER FOOD STAMP APPL. $0.00
DHS-854SP REV 7/17 C GA DISASTER FOOD STAMP APPL. $0.00
DHS-855 REV 5-11 C DISASTER FOOD STAMP PROGRAM WORKSHEET $0.00
DHS-855SP REV 5-11 C DISASTER FOOD STAMP PROGRAM WORKSHEET (SP) $0.00
DHS-901 REV 11-15 C COMMODITY SUPPLEMENTAL FOOD PROGRAM APPLICATION $0.00
DHS-901SP REV 11-15 C COMMODITY SUPPLEMENTAL FOOD PROGRAM APPLICATION (SP) $0.00
DHS-902 REV 11-15 C ELIGIBILITY NOTIFICATION LETTER $0.00
DHS-902SP REV 11-15 C ELIGIBILITY NOTIFICATION LETTER (SP) $0.00
DHS-903 REV 11-15 C PARTICIPANT AGREEMENT $0.00
DHS-903SP REV 11-15 C PARTICIPANT AGREEMENT (SP) $0.00
DHS-904 REV 11-15 C CLOSURE NOTIFICATION LETTER $0.00
DHS-904SP REV 11-15 C CLOSURE NOTIFICATION LETTER (SP) $0.00
DHS-905 REV 11-15 C VERIFICATION OF CERTIFICATION FORM $0.00
DHS-905SP REV 11-15 C VERIFICATION OF CERTIFICATION FORM (SP) $0.00
DHS-906 REV 11-15 C DISQUALIFICATION NOTICE $0.00
DHS-906SP REV 11-15 C DISQUALIFICATION NOTICE SPANISH $0.00
DHS-907 REV 11-15 C AUTHORIZED REPRESENTATIVE DESIGNATION $0.00
DHS-907SP REV 11-15 C AUTHORIZED REPRESENTATIVE DESIGNATION (SP) $0.00
DHS-909 REV 9-15 C WAITING LIST $0.00
DHS-910 REV 5-17 C ISSUANCE REGISTER $0.00
DHS-911 REV 9-15 C LDA MONTHLY FOOD DISTRIBUTION REPORT $0.00
DHS-912 REV 7-19 C VERIFICATION CHECKLIST 8.5X11 2 PART NCR 1 SIDED $0.00
DHS-912SP REV 7-19 C VERIFICATION CHECKLIST SPANISH $0.00
DHS-913 REV 9-15 C RECERTIFICATION FORM $0.00
DHS-914 REV 11-15 C RECERTIFICATION STATUS NOTIFICATION $0.00
DHS-914SP REV 11-15 C RECERTIFICATION STATUS NOTIFICATION (SP) $0.00
DHS-915 REV 7-19 C RECERTIFICATION LETTER A 8.5X11 2 PART NCR 1 SIDE $0.00
DHS-915SP REV 7-19 C RECERTIFICATION LETTER A SPANISH $0.00
DHS-916 REV 7-19 C RECERTIFICATION LETTER WL 8.5X11 2 PART NCR 1 SIDED $0.00
DHS-916SP REV 7-19 C RECERTIFICATION LETTER WL SPANISH $0.00
DHS-919 REV 11-16 C CSFP WRITTEN NOTICE FORM $0.00
DHS-920 REV 11-16 C CSFP BENEFICIARY REFERRAL REQUEST FORM $0.00
DHS-928ENG-SP C APPLYING FOR BENEFITS $0.00
DHS-929ENG-SP C FORGOT USER ID/PASSWORD $0.00
DHS-930ENG-SP C RENEWING BENEFITS $0.00
DHS-931ENG-SP C REPORTING CHANGES $0.00
DHS-932ENG-SP C SUBMITTING DOCUMENTS $0.00
DHS-933 REV 4-17 C SELF SERVICE PROMPT ENGLISH $0.00
DHS-933SP REV 4-17 C SELF SERVICE PROMPT SPANISH $0.00
DHS-94A REV 9-17 C APPLICATION HEALTH COVERAGE & HELP PAYING COST $0.00
DHS-94ASP REV 9-17 C APPLICATION HEALTH COVERAGE & HELP PAYING COST- SPANISH $0.00
DHS-95 REV 10-12 C CONTACT LTR CKLIST FOR FAMILY MEDICAID $0.00
DHS-95SP REV 10-12 C CONTACT LTR CKLIST FOR FAMILY MEDICAID $0.00
DHS-981 REV 3-11 C CONTACT LETTER/WAGE VERIF CKLIST ABD MED $0.00
DHS-985 REV 2-10 C ABD MEDICAID BURIAL DESIGNATION $0.00
DHS94A AP A REV 9-17 C HEALTH COVERAGE FROM JOBS $0.00
DHS94A AP B REV 9-17 C AMERICAN INDIAN OR ALASKA NATIVE FAMILY MEMBER (AI/AN) $0.00
DHS94A AP C REV 9-17 C ASSISTANCE WITH COMPLETING THIS APPLICATION $0.00
DHS94ASP AP A RV9-17 C HEALTH COVERAGE FROM JOBS SPANISH $0.00
DHS94ASP AP B RV9-17 C AMERICAN INDIAN OR ALASKA NATIVE FAMILY MEMBER (AI/AN) $0.00
DHS94ASP AP C RV9-17 C ASSISTANCE WITH COMPLETING THIS APPLICATION SPANISH $0.00
FSSCAREGUIDENGR12-14 C FAMILY SUPPORT SERVICES CAREGIVER'S GUID ENG REV 12-14 $0.00
FSSCAREGUIDSPR12-14 C FAMILY SUPPORT SERVICES CAREGIVER'S GUIDE SP REV 12-14 $0.00
SAFETYPLAN ENG7-20 C GA SAFETY PLAN- ENGLISH 8.5X11 2P NCR W/C 1-SIDE $0.00
SAFETYPLAN SP7-20 C GA SAFETY PLAN- SPANISH 8.5X11 2PNCR W/C 1 SIDE $0.00
SNAP WORKS REV 2-19 C 8.5X11 2-SIDE DO YOU KNOW THATSNAP WORKS? FIND OUT HOW IT $0.00
SUPPORTAGREE ENG7-20 C SAFETY PLAN SUPPORT PERSON AGREEMENT- ENGLISH $0.00
SUPPORTAGREE SP7-20 C SAFETY PLAN SUPPORT PERSON AGREEMENT- SPANISH $0.00