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Mi dhhs 2026
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- Click ‘Get Form’ to open the mi dhhs application in the editor.
- Begin by filling out the 'Sponsoring Agency Information' section. Enter the name, federal ID number, address, city, state, zip code, and county of your sponsoring agency. Ensure that you provide the administrator's name, title, email, and direct phone number.
- Proceed to the 'Provider & Agreement Information' section. Fill in the provider's last name, first name, middle name, title (select from options like MD or Nurse Practitioner), and discipline/specialty. Include their expected employment start date and email.
- In the 'Practice Site Information' section, confirm if the applicant will work at least 40 hours per week for no less than 45 weeks per year. Provide details for each practice site including physical address and manager contact information.
- Complete the 'Certification of Compliance and Declaration of Intent' section by reviewing all requirements and signing off as the administrator. Make sure all information is accurate before submitting.
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