Paperwork for health and human services 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the Certificate Holder Information section. Enter your name, birth date, BEI certification number, certification level, and address details including city, state, ZIP code, and county.
3. Indicate whether you have a felony conviction by selecting 'Yes' or 'No'. If 'Yes', provide the conviction date.
4. Complete the Contact Information section with your daytime phone number, email address, and optional cell and video phone numbers.
5. Decide if you want your information published in the DHHS registry by selecting 'Yes' or 'No'.
6. In the Maintenance Method section, select the appropriate renewal fee based on when you are submitting this form relative to your expiration date.
7. Ensure you enclose a check or money order for the maintenance fee as instructed. Then mail this form along with payment to DARS DHHS at the provided address.
8. Finally, sign and date the application to confirm that all information is accurate and that you agree to abide by the Code of Professional Conduct.

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