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Dhs 1046 semi annual contact report

Mi dhhs 2026

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4.8 out of 5

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The document is an application form for the Michigan State Loan Repayment Program (MSLRP) administered by the Michigan Department of Health and Human Services. It collects information from sponsoring agencies and healthcare providers regarding their practice sites, employment details, and compliance with program requirements. The form emphasizes the need for not-for-profit practice sites, provider contributions to loan repayment agreements, and adherence to specific employment regulations. It also includes a certification statement affirming the intent to employ the provider throughout the loan agreement period.

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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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Versions	Form popularity	Fillable & printable
2021	4.8 Satisfied (39 Votes)
2020	4.1 Satisfied (37 Votes)
2019	4.2 Satisfied (59 Votes)

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Is it safe to sign my semi annual contact form dhs michigan electronically?

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How to apply for dhs car voucher michigan?

The best way to apply for assistance is online using MI Bridges. If you need to use this paper application, keep in mind that youll need to print and complete the application, and then take it to your local MDHHS office.

What is the path program in Michigan?

(PATH) program helps participants transition off public assistance to obtain and maintain employment, earn wages and develop self-sustainability. PATH is a partnership between Workforce Development (WD), the Michigan Department of Health and Human Services (MDHHS), and Michigan Works! Agencies (MWAs).

What does Dhhs stand for?

U.S. Department of Health and Human Services.

dhhs application form

MDHHS login MIBridges MDHHS phone number MI Bridges Login MDHHS MI Bridges MDHHS Office MDHHS Medicaid MDHHS phone number 844

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What does the Michigan Department of Human Services do?

The Michigan Department of Health and Human Services (MDHHS) is a principal department of state of Michigan, headquartered in Lansing, that provides public assistance, child and family welfare services, and oversees health policy and management, including mental health and substance abuse services.

How do I apply for DHS in Michigan?

The most efficient way to determine eligibility is to apply online using the Michigan Bridges online application portal. To view, print or complete a paper application, download the DHS Information Booklet. Application(s) may be hand delivered, mailed or faxed to the local DHS office.

Does Michigan DHS help with a car?

THE MAXIMUM AMOUNT WE PROVIDE IS $3000.00 TO GO TOWARDS THE PURCHASE OF A CAR.

Is Healthy Michigan Plan the same as Medicaid?

The Healthy Michigan Plan is a Medicaid health care program through the Michigan Department of Health and Human Services (MDHHS).

How do I speak to someone at DHS in michigan?

If you have questions about your case, you can call 1-844-4MI-DHHS (1-844-464-3447).