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Click ‘Get Form’ to open it in the editor.
In the first field, enter the 'Print Name of Provider'. This should be the official name of your health care facility providing nursing services.
Next, navigate to the 'Signature' field. Here, you will need to sign your name, confirming that all information provided is accurate.
Finally, locate the 'Date Signed' field. Enter the date on which you are signing this form to complete your submission.

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What is DHS form I 193?

I-193, Application for Waiver of Passport and/or Visa. For an alien who is a legal resident of the United States to reenter the United States without the aliens passport and/or visa.

What is the required form for departing DHS?

The required form that all employees must complete before departing is Form 132-01, DHS Exit Checklist. The Federal legislation that supports the DHS (Department of Homeland Security) records management mission is the Federal Records Act of 1950.

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