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DHHS Assurance of Compliance Forms
Jun 28, 1993 THIS ASSURANCE is given in consideration of and for the purpose of obtaining any and all Federal grants, loans, contracts, property, discounts
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Applications and Forms - CT.gov
This form is for use by individuals requesting an assessment of spousal assets when one spouse starts a continuous period of institutionalization.
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AUTHORIZATION TO DISCLOSE PROTECTED HEALTH
I AUTHORIZE THE MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES (MDHHS) TO SHARE MY HEALTH INFORMATION: List the amount or type of information you would
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