2275
This Form is used for applying for initial licensure or renewal of licensure as a professional judge in Indiana.
This form is used for applying for initial licensure or renewing licensure as a second for a professional fighter in the state of Indiana.
This form is used for applying for a position change or replacement badge in the state of Indiana.
This form is used for applying for initial licensure or renewal of licensure as a professional boxer in the state of Indiana.
This form is used for applying for initial licensure or renewal of licensure as a trainer of a professional fighter in the state of Indiana.
This Form is used for individuals in Indiana who need to apply for an occupational license separation from service or suspension.
This form is used for applying to renew the annual pull tab license in the state of Indiana.
This document is used for the designation and appointment of a trustee for the purpose of conducting casino gambling operations in the state of Indiana.
This Form is used for receiving a notice and order of denial of an occupational license application in the state of Indiana.
This form is used for the Manufacturer/Distributor Quarterly Report in the state of Indiana.
This Form is used for requesting amendments to a license in the state of Indiana.
This document is used for reporting the summary of an event involving pull tab, punchboard, or tip board games in the state of Indiana.
This form is used for applying for initial licensure or renewal of licensure as an event physician in the state of Indiana.
This Form is used for applying for an initial or renewal licensure as a professional referee in the state of Indiana.
This form is used for applying for initial licensure or renewal of licensure as a professional matchmaker in Indiana.
This form is used for investigating leptospirosis cases in the state of Indiana.
This document is used for conducting an investigation on a severe Staphylococcus aureus infection in a previously healthy person in Indiana.
This form is used for documenting the summary and conducting contact investigations for Tuberculosis cases in Indiana.
This form is used for recording the HIV test history and assessment of pregnant women in the state of Indiana.
This form is used for conducting a case investigation of Hepatitis C in Indiana. It helps collect important information about the virus, its transmission, and the individuals affected.
This Form is used for requesting a waiver for tuberculosis testing in the state of Indiana.
This Form is used for recording vaccine administration for children and teens in Indiana.
This Form is used for conducting a Varicella (Chickenpox) Case Investigation in the state of Indiana. It helps health officials gather important information about individuals diagnosed with chickenpox to monitor outbreaks and prevent further transmission.
This form is used for investigating cases of perinatal hepatitis B in Indiana.
This form is used for applying for a proficiency certification for limited radiographer in the state of Indiana.
This Form is used for maintaining the confidentiality of information related to the Indiana Division of Hearings and Appeals (IDHA) and the Indiana Bureau of Rehabilitation Services (IBRS).
This form is used for the Indiana Adoption Medical History Registry in the state of Indiana. It allows individuals involved in the adoption process to provide medical history information.
This form is used for applying for approval of a radiology program in the state of Indiana. It is required for individuals or institutions seeking to offer radiology educational programs.
This document is an agreement between parties in the state of Indiana for a lump sum payment. It outlines the terms and conditions of the payment and serves as a legally binding contract.
This Form is used for providing consent to share identifying information in the Indiana Adoption Matching Registry.
This Form is used for removing user access from the Indiana Birth/Death Registration System (IBRS) or (IDRS) in Indiana.
This form is used for making changes to a birth record in Indiana, such as establishing paternity or making other necessary amendments.
This form is used for the agreement to compensation between the dependents of a deceased employee and the employer in the state of Indiana.
This Form is used to establish paternity for a child who is less than sixty (60) days old in Indiana through the local health department.
This Form is used for reporting a physician's medical assessment or evaluation in the state of Indiana.
This form is used for notifying the state of Indiana when you are unable to determine your liability or need additional time to do so.