North Dakota Department of Health and Human Services Forms

This form is used for enrolling and staffing schedules in North Dakota.

This Form is used for scheduling appointments for Health Tracks program in North Dakota.

This type of document is used for submitting attachments with the SFN177 MMIS form in North Dakota.

This document is used in North Dakota to certify Medicaid services provided out of state.

This Form is used for healthcare providers in North Dakota to enter into agreements for participation in the Medicaid and Basic Care Assistance Programs.

This form is used for tracking health history in North Dakota.

This form is used for pediatric assessment in North Dakota to track the health and development of children.

This form is used for requesting service authorization for out-of-state services in North Dakota.

This form is used for registering radiation machines in North Dakota.

This form is used for notifying the state of North Dakota about concrete and asphalt recycling facilities. It serves as a way to comply with regulations and provide necessary information about the facility.

This form is used for applying for the beneficial use of inert waste in North Dakota.

This form is used for submitting an application for the beneficial use of inert waste in North Dakota transportation projects.

This document is used to record the shipment of waste containing asbestos materials in North Dakota.

This type of document is used for conducting inspections of large quantity generators and treatment, storage, and disposal facilities (TSDFs) in North Dakota. It includes a checklist to ensure compliance with regulations and proper hazardous waste management.

This form is used for tracking and documenting the disposal of asbestos waste in North Dakota. It ensures proper handling and disposal of hazardous materials to protect the environment and public health.

This form is used for applying to obtain a variance for open burning of clean wood at landfills in North Dakota.

This Form is used for applying for a waste disposal variance in North Dakota.

This Form is used for applying for a permit to operate a solid waste management facility in North Dakota.

This form is used for applying for a variance for the disposal of inert waste in North Dakota as part of NDDOT projects.

This form is used for conducting inspections of inert waste landfills in North Dakota. It helps ensure compliance with regulations and proper waste management practices.

This document is a variance application for the disposal of inert waste in North Dakota. It is used to request permission for the disposal of waste materials that are non-hazardous and do not undergo significant physical or chemical changes.

This form is used for submitting an annual report for an inert waste facility located in North Dakota.

This form is used for submitting an annual report on land treatment activities in North Dakota.

This form is used for applying for a land treatment variance in North Dakota.

This form is used for applying for a license to operate as a scrap iron processor in the state of North Dakota.

This form is used for the release of abandoned motor vehicles or scrap metal through the Abandoned Automobile Program in North Dakota.

This form is used for requesting reimbursement through the Abandoned Motor Vehicle Program in North Dakota. It is for individuals or entities seeking reimbursement for expenses incurred while participating in the program.

This document is used for tracking and planning the application of fertilizer or manure on agricultural land in North Dakota.

This Form is used for reporting the rejection of waste in North Dakota.

This Form is used for applying for a permit to transport solid waste in North Dakota.

This document is a checklist that is used for conducting a monthly walk-through inspection in North Dakota. It helps to ensure that all necessary areas are checked and maintained regularly.

This monthly walk-through inspection checklist is specifically designed for impressed current underground storage tanks (USTs) in North Dakota. It outlines the necessary steps and procedures to ensure the safe and proper maintenance of these USTs.

This form is used for inspecting the operation of automatic tank gauges in North Dakota.

This form is used for notifying the state of North Dakota about underground storage tanks.

This document is used for recording manual tank gauging measurements in North Dakota. It is a form that helps track the volume of liquids in tanks without using automated systems.

This form is used for recording monthly interstitial monitoring of piping in North Dakota.

This document is used for recording the monthly visual inspection of the piping sump in North Dakota.