2275
This form is used for filing an application for adjustment of claim in the state of Indiana. It is used to request a review and potential adjustment of a previously submitted claim.
This form is used for requesting a transfer from one department or location to another within the state of Indiana.
This form is used for providing a notice of intent in the state of Indiana. It is specifically related to Rule 5 of State Form 47487.
This form is used for submitting an affidavit in the state of Indiana. It is a legal document that allows individuals to provide sworn statements or evidence to support a claim or case.
This Form is used for reporting the first report of employee injury or illness for workers' compensation in the state of Indiana.
This form is used for recording and calculating compensatory time for employees in the state of Indiana.
This form is used for creating a custodial statement and agreement for third-party custody in the state of Indiana.
This Form is used for electing to either pay tax or become liable for payment in lieu of contributions in the state of Indiana.
This Form is used for documenting custodial arrangements and agreements related to divorce, separation, or abandonment in the state of Indiana. It is an important legal document that outlines the responsibilities and rights of each parent or guardian regarding the care and custody of their children.
This type of document is used for custody agreements and declarations in the case of divorce, separation, or abandonment in the state of Indiana.
This form is used for parents who are divorced or separated to make election to send their child to a specific school in Indiana.
This Form is used for reporting the locations of Indiana businesses. It helps the state government track and regulate businesses operating within Indiana.
This form is used for applying to inspect moisture testing equipment in Indiana.
This form is used for requesting access to public records in the state of Indiana. It allows individuals to request information from government agencies or organizations that are required to make their records available to the public.
This Form is used for enrolling students in IT technical training programs in Indiana. It is used to collect necessary information and contact details from the students to facilitate the enrollment process.
This form is used for enrolling students in PC end user training courses in Indiana. It includes fields for personal information, contact details, and course preferences.
This Form is used for filing a formal complaint with the Office of the Public Access Counselor in the state of Indiana.
This Form is used for selecting an authorized representative for health coverage in Indiana.
This Form is used for authorizing the disclosure of personal and health information in the state of Indiana.
This form is used for revoking authorization in the state of Indiana.
This Form is used for designating a protective payee for the Hoosier Works Card in Indiana.
This form is used for applying for SNAP and cash assistance in the state of Indiana.
This Form is used for applying for SNAP and cash assistance in Indiana. (Spanish)
This form is used for providing a notice to Indiana residents about their rights and responsibilities regarding health coverage.
This Form is used for voluntary clients in Indiana to understand their impact responsibilities, sanctions, and rights.
This Form is used for informing individuals in Indiana about their rights and responsibilities for the Supplemental Nutrition Assistance Program (SNAP) and Cash Assistance.
This document is used for providing notice of rights and responsibilities for health coverage in Indiana.
This Form is used for applying for SNAP (Food Stamps) and cash assistance in Indiana. It is specifically for individuals who speak Burmese.
This form is used to provide notice related to the rights and responsibilities of the Supplemental Nutrition Assistance Program and Cash Assistance program in Indiana.
This form is used in Indiana to create an Individualized Family Service Plan (IFSP) for children with special needs. The purpose is to enhance the capacity of families to support their children's specific needs.
This form is used for informing job applicants in Indiana about their rights and responsibilities during the job search process.
This type of document, Formulario del Estado 55371 (DFR2123S) Representante Autorizado Cobertura De Salud - Indiana, is used for obtaining authorized representation for health coverage in the state of Indiana.
This form is used for acknowledging agency policies and procedures in the state of Indiana.
This form is used for verifying the disability status of a dependent individual in the state of Indiana.
This Form is used for making changes to position data in Indiana.