Alaska Department of Health and Social Services Forms

This form is used for submitting a Quality Improvement Report (QIR) in Alaska.

This form is used to request a remote allowance for personal care assistants in Alaska who need to undergo First Aid and CPR training. The remote allowance covers the costs associated with traveling to and attending the training sessions.

This form is used for obtaining consent from individuals in Alaska for conducting Teleassessment for Intellectual and Developmental Disabilities (IDD).

This type of document serves as a record of viewing and completion for the training video required for mandated reporters in Alaska.

This form is used for pre-admission screening and resident review in the state of Alaska. It helps determine if a person is eligible for long-term care services and assesses their needs before admission to a care facility.

This document is a log used to track presentations related to Medicare in Alaska. It helps keep a record of when and where these presentations took place.

This document is a privacy and security agreement for individual providers in Alaska using the Harmony Data System. It outlines the measures taken to protect the privacy and security of user data.

This document is used for invoicing the facilitation site fee in the state of Alaska. It is used to request payment for the use of a facilitation site.

This document is an application for the Alaska Commodity Supplemental Food Program (CSFP) which provides food assistance to eligible individuals in Alaska.

This Form is used for calculating self-employment income and deductions for individuals in Alaska.

This Form is used for reporting changes in family circumstances for residents of Alaska.

This form is used for providing a statement of employment in the state of Alaska. It is typically used by employers to verify an individual's employment status.

This Form is used for keeping a monthly record of tips in Alaska. Keep track of your tips with this ledger.

This Form is used for applying for Alaska Inclusive Child Care services in Alaska.

This form is used for reporting health status in Alaska.

This form is used for terminating child care services in Alaska.

This form is used for requesting a hearing in the state of Alaska.

This form outlines the health and safety requirements for approved relative child care providers in Alaska.

This form is used for submitting a request for additional payment in the state of Alaska.

This form is used for approved child care providers in Alaska to create a disaster preparedness and emergency evacuation plan for the safety of children in their care.

This form is used to determine the rates and responsibilities for child care providers in Alaska. It outlines the expectations for payment and the duties that providers are responsible for.

This form is used for establishing an agreement between parents and in-home child caregivers in Alaska. It ensures clear understanding and expectations regarding childcare arrangements.

This form is used for applying for in-home child care in Alaska. It serves as an application for individuals who wish to provide child care services in their own homes.

This form is used for applying to become an approved relative child care provider in Alaska.

This Form is used for submitting a general variance application in Alaska.

This form is used for acknowledging and agreeing to a financial repayment plan in Alaska.

This form is used to request permission to operate a child care business in Alaska. It is necessary for individuals or organizations seeking to provide child care services in the state.

This Form is used for making an amended request for payment in the state of Alaska.

This form is used for requesting payment in the state of Alaska.

This form is used for ensuring health and safety standards in in-home child care facilities in Alaska. It outlines the specific requirements that must be met to maintain a safe environment for children.

This form is used for reporting changes in the Child Care Assistance Program provider information in Alaska.

This Form is used for renewing the in-home child care license in Alaska.

This Form is used for recording the daily attendance of children in Alaska.

This form is used for conducting an inspection of in-home child care facilities in Alaska to ensure health and safety standards are being met.

This form is used for reporting instances of non-payment by a family in Alaska.

This form is used for reporting and documenting emergency evacuation drills that have taken place in Alaska. It helps ensure the safety and preparedness of individuals in the event of an emergency.

This Form is used for renewing the approval of a relative child care provider in Alaska.

This form is used for requesting a Pass I Child Care in Alaska.