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Paperwork for health and human services 2026
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- Click ‘Get Form’ to open it in the editor.
- 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.
- Indicate whether you have a felony conviction by selecting 'Yes' or 'No'. If 'Yes', provide the conviction date.
- Complete the Contact Information section with your daytime phone number, email address, and optional cell and video phone numbers.
- Decide if you want your information published in the DHHS registry by selecting 'Yes' or 'No'.
- In the Maintenance Method section, select the appropriate renewal fee based on when you are submitting this form relative to your expiration date.
- 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.
- 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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See more form h0003 versions
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2011 | 4.8 Satisfied (81 Votes) |
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