• Assistance Application (DHS-1171) A packet containing an application for assistance, an information booklet and a filing form. The best way to apply for assistance is online using MI Bridges. If you need to use this paper application, keep in mind that after you've completed the application, you will need to print it and take it to your local DHS office.

• Solicitud de Asistencia - DHS-1171-SP

• DHS-1171-AR 

• Central Registry Clearance Request - DHS-1929

• Original License Application Packet Adult Foster Care, Child Day Care, Child Caring Institution, or Child Placing Agency

• Energy Supplier Participation Agreement - DHS-355 

• Adult Services Application - DHS-390 

• Adult Foster Care License Limited Liability Company Governmental Organization and Corporate Application - BCAL-569-C 

• Adult Foster Care License Individual Application - BCAL-569-I 

• Supplemental Application for State Emergency Relief - DHS-1514 

• Plan First! Family Planning Program Application - MSA-1582 

• Insurance Assistance Program and Insurance Assistance Program-Plus Application - DHS-1661 

• Solicitud Para Medicaid Retroactivo - DHS-3243-SP 

• Retroactive Medicaid Application - DHS-3243 

• Medicaid Application Patient of Nursing Home - DHS-4574 

• Asset Declaration Patient and Spouse - DHS-4574-B 

• Declaration De Bienes Paciente Y Esposo/A - DHS-4574-B-SP 

• Child Development and Care Application - DHS-4583 

• Solicitud de Desarrollo y Cuidado de Niños - DHS-4583-SP 

• Voter Registration Application and Michigan Driver License/Personal Identification Card Address Change Form - NSP-0938-B 

• Solicitud de Registración del Votante y Licencia de Manejar de Michigan/Instrucciones de la Forma para Cambiar su Dirección en su Tarjeta de Identificación Personal - NSP-0938B-SP 

• Personal Reference Letter - DHS-608 

• Notification to Court of Jurisdiction and Child's Lawyer Guardian Ad Litem - DHS-867 

• Request for Medical Subsidy for An Adopted Child - DHS-1341-A 

• Adult Former Sibling Statement to Release Information to Adult Adoptee - DHS-1917 

• Release of Information to Adult Adoptee by Brother/Sister as proxy for Deceased Parent - DHS-1918 

• Parent's Consent/Denial to Release Information to Adult Adoptee - DHS-1919 

• Release of Information Authorization Adult Adoptee - DHS-1920 

• Request by Adult Adoptee for Identifying Information - DHS-1925 

• Adoption Facilitator Clearing House Record, DHS-4746 Adoption Facilitator Clearing House Record, - DHS-4746

• Medical Needs - DHS-54-A 

• Adult Services Application - DHS-390 

• Personal Care Services Provider Log - DHS-721 

• Insurance Assistance Program and Insurance Assistance Program-Plus Application - DHS-1661 

• Assistance Application (DHS-1171) A packet containing an application for assistance, an information booklet and a filing form. The best way to apply for assistance is online using MI Bridges. If you need to use this paper application, keep in mind that after you've completed the application, you will need to print it and take it to your local DHS office.

• Solicitud de Asistencia - DHS-1171-SP

• Solicitud Para Medicaid Retroactivo - DHS-3243-SP 

• Retroactive Medicaid Application - DHS-3243 

• Asset Declaration Patient and Spouse - DHS-4574-B 

• Medicaid Application Patient of Nursing Home - DHS-4574 

• Declaration De Bienes Paciente Y Esposo/A - DHS-4574-B-SP 

• Assistance Application (DHS-1171) A packet containing an application for assistance, an information booklet and a filing form. The best way to apply for assistance is online using MI Bridges. If you need to use this paper application, keep in mind that after you've completed the application, you will need to print it and take it to your local DHS office.

• Verificacion del Proveedor del Cuidado del Nino - DHS-4025-SP 

• Child Care Provider Verification - DHS-4025 

• DHS-1171-AR 

• Solicitud de Asistencia - DHS-1171-SP

• CDC Daily Time and Attendance Record 

• Child Development and Care Application - DHS-4583 

• Solicitud de Desarrollo y Cuidado de Niños - DHS-4583-SP 

• In Home Care Certification - DHS-167 

• In Home Care Certification - DHS-167 (Word)

• Basic Grant Certification - DHS-168 

• Monthly Report on Foster Care Under the Family Division of the Circuit Court - DHS-207 

• Monthly Report on Foster Care Under the Family Division of the Circuit Court - DHS-207 (Word)

• County Child Care Budget Summary - DHS-2091 (Word)

• County Child Care Budget Summary - DHS-2091 

• In Home Care Summary - DHS-2093 (Word)

• In Home Care Summary - DHS-2093 

• In Home Care/Basic Grant Budget Detail Report - DHS-2094 

• In Home Care/Basic Grant Budget Detail Report - DHS-2094 (Word)

• Basic Grant Summary - DHS-2095 

• Basic Grant Summary - DHS-2095 (Word)

• In Home Care Addendum for DHS-206B - DHS-2396 

• In Home Care Addendum for DHS-206B - DHS-2396 (Word)

• In Home Care/Basic Grant Program Component Report/Request - DHS-4471 (Word)

• In Home Care/Basic Grant Program Component Report/Request - DHS-4471 

• Child Care Fund Summary Report - DHS-4472 

• Child Care Fund Summary Report - DHS-4472 (Word)

• Child Support Information - DHS-0842 (Word) When requested, complete this form to provide information to your caseworker.

• IV-D Child Support Services Application/Referral - DHS-1201  If you are not on public assistance, complete this form to apply for Child Support services

• DHS Child Support Form and Publication Order Form - DHS-1454 

• Solicitud Para Servicios de Sostenimento de Ninos (IV-D)/Recomendacion - DHS-1201-SP  Si usted no está recibiendo asistencia pública, rellene este formulario para solicitar los servicios de Mantenimiento de Hijos

• Central Registry Clearance Request - DHS-1929

• Relative Search Information - DHS-988 (WORD)

• Relative Search Information(Busqueda de Informacion de Parentesco) - DHS-988-SP

• Relative Response Form - DHS-989 (WORD)

• Relative Notification Form Letter for CPS and Foster Care - DHS-990 (WORD)

• Report of Actual or Suspected Child Abuse or Neglect - DHS-3200 

• INFORMACIÓN SOBRE ABUSO O DESCUIDO DE NIÑOS REAL O SOSPECHADO - DHS-3200-SP 

• Report of Actual or Suspected Child Abuse or Neglect (Arabic Version) - DHS-3200-AR 

• State of Michigan Sudden & Unexplained Child Death Scene Investigation Form 

• Your EITC refund belongs to you 

• Earned Income Tax Credit Temporary Assistance for Needy Families (TANF) - DHS-3043 

• Asistencia Federal Temporal a Familias Necesitadas (TANF) Determinación de Elegibilidad - DHS-3043-SP 

• Assistance Application (DHS-1171) A packet containing an application for assistance, an information booklet and a filing form. The best way to apply for assistance is online using MI Bridges. If you need to use this paper application, keep in mind that after you've completed the application, you will need to print it and take it to your local DHS office.

• Solicitud de Asistencia - DHS-1171-SP

• DHS-1171-AR 

• Energy Supplier Participation Agreement - DHS-355 

• Supplemental Application for State Emergency Relief - DHS-1514 

• Solicitud Para Ayuda de Emergencia del Estado - DHS-1514-SP 

• Assistance Application (DHS-1171) A packet containing an application for assistance, an information booklet and a filing form. The best way to apply for assistance is online using MI Bridges. If you need to use this paper application, keep in mind that after you've completed the application, you will need to print it and take it to your local DHS office.

• Solicitud de Asistencia - DHS-1171-SP

• DHS-1171-AR 

• Search for a Court Form.

• Interstate Compact on Juveniles Petition for Requsition to Return a Runaway Juvenile - DHS-1908  ICJ Form A

• Detention Order - DHS-1909 

• Recommendation and Assurance for Pre-Adoption and Requirement Certification - DHS-3005 

• Interstate Compact on Juveniles Out of State Travel Permit and Agreement to Return - DHS-3034  ICJ Travel Permit

• Interstate Compact on Juveniles Requisition for Escapee/Absconder/Juvenile Charged Delinquent (Rendition Amendment) - DHS-3036  ICJ Juvenile Rights

• Interstate Compact on Juveniles Consent for Voluntary Return by Runaway, Escapee or Absconder - DHS-3037  ICJ Form III

• Interstate Compact on Juveniles Parole or Probation Investigation Request - DHS-3038  ICJ Form IV

• Interstate Compact on Juveniles Parolee/Probationer Report to Receiving State - DHS-3039  ICJ Form V

• Interstate Compact on Juveniles Application for Services and Waiver - DHS-3040  ICJ Form 1A-VI

• Sending State Priority Home Study Request - DHS-3750 

• Interstate Compact Placement Request - DHS-4332 

• Interstate Compact Report on Child's Placement Status - DHS-4333 

• ICPC Financial/Medical Plan - DHS-4334 

• Interstate Compact Checklist - DHS-4335 

• Interstate Compact on the Placement of Children Placement Prescreening - DHS-4336 

• Resident Forms

• AFC Forms Request 

• AFC Sample Starter Packet 

• Worksheet for Rating Residents 

• Worksheet for Calculating Evacuation Difficulty Score 

• Finding the Staff Shift Score 

• Original License Application Packet Adult Foster Care, Child Day Care, Child Caring Institution, or Child Placing Agency

• Resident Register - BCAL-0535 

• Adult Foster Care License Limited Liability Company Governmental Organization and Corporate Application - BCAL-569-C 

• Adult Foster Care License Individual Application - BCAL-569-I 

• Homes for the Aged Application for Licensure - BCAL-1600 

• Homes for the Aged Certificate of Appointment of Authorized Representative - BCAL 1603 

• HFA Administrator Appointment - BCAL-1606 

• Request for Plan Review - BCAL-1605 

• Certification of Specialized Programs Application - BCAL-1609  Must currently be licensed to be certified

• Appointment of Home for the Aged Resident Authorized Representative - BCAL-1610 

• Resident Funds Record Part 1(*) - BCAL-2318 

• Resident Funds Record Part II(*) - BCAL-2319 

• Assessment Plan for AFC Residents - BCAL-3265

• Resident Care Agreement(*) - BCAL-3266 

• AFC Resident Medication Record - BCAL-3267 

• Appointment of Designated Representative - BCAL-3268 

• What is a Designated Representative - BCAL-3268-I 

• Resident Information and Identification Record - BCAL-3483 

• Resident Weight Record - BCAL-3485 

• Medical Clearance Request - BCAL-3704 

• Resident Health Care Appraisal(*) - BCAL-3947 

• AFC Incident/Accident Report(*) - BCAL-4607 

• Request for Modification of the Terms of the Registration/License - BCAL-5055 

• AFC/HFA Sample Corrective Action Plan - BCAL-0414 

• Child Care Forms Request 

• Application for Child Care Plan Review - BFS-13 (Required for new building/renovations only.) 

• Annual Compliance Certification for School Age Programs Exempt from Inspections 

• Central Registry Clearance Request - DHS-1929

• Original License Application Packet Adult Foster Care, Child Day Care, Child Caring Institution, or Child Placing Agency

• Child Care Center Compliance Record, Part 8 - BCAL-722  Part 8. Fire Safety Mainetance

• Employee Notification to Child Care Center of Arraignment - BCAL-1486 

• Child Care Center Compliance Record, Part 1 - BCAL-1888  Part 1. General Provisions

• Child Care Center Compliance Record, Part 2 - BCAL-1889  Part 2. Infants/Young Toddler/Older Toddler

• Child Care Center Compliance Record, Part 3 and 5 - BCAL-1890  Parts 3 and 5. Additional Provisions (School-Age/Swimming)

• Child Care Center Compliance Record, Part 6 - BCAL-1891  Part 6. Transportation Provision

• Infant/Toddler Primary Caregiver Documentation - BCAL-4557 

• Fire/Tornado Drill Record - BCAL-4594 (Word)

• Assistant Caregiver Certifications - BCAL-4595 

• Incident Report - BCAL-4605 

• Staffing Plan: Child Care Centers - BCAL-5001 (Excel) 

• Driver Verification - BCAL-5039 

• Child Care Center Record Requirements - BCAL-5041

• Self-Certification of Transportation Provisions for Centers - BCAL-5044 

• Certification for Field Trip Transportation - BCAL-5046 

• Playground Inspection Certification Summary - BCAL-5047 

• Certification by Third-Party Substitute Contracting Agency - BCAL-5051 

• Licensing Notebook Summary Sheet - BCAL-5052 

• Parent Notification of the Licensing Notebook - BCAL-5053 

• Request for Modification of the Terms of the License/Registration - BCAL-5054 

• Sample Attendance Record 

• Sample Attendance Record 

• Medication Permission and Instructions for Child Care Homes/Child Care Centers - BCAL-1243 

• Permiso e Instrucciones Para la Medicación Para Casas de Cuidado/Guarderias - OCAL-1243-SP 

• Licensing Record Clearance Request - BCAL-1326-CC 

• Medical Clearance Request - BCAL-3704 

• Child Information Record - BCAL-3731 

• Child Information Record - BCAL-3731-AR (Arabic) 

• Documento de Información del Niño Estado de Michigan - BCAL-3731-SP 

• Child in Care Statement/Receipt - BCAL-3900 

• Declaración/Recibo de Niños en Cuidado - BCAL-3900-SP 

• Training Record Family/Group Child Care Homes - BCAL-4590 

• Incident, Accident, Illness, Death or Fire Report - BCAL-4603 

• Child Care Center Compliance Record, Part 9 - BCAL-4668  Part 9. Environmental Health/Sanitation Maintenance

• Staffing Plan: Child Care Centers - BCAL-5001 

• Child Care Licensee Designee - BCAL-5003 

• School Building Fire Inspection Certification - BCAL-5043 

• Initial Foster/Adoption Home Evaluation - BCAL-3130 This form MUST be saved to your personal computer in order to do spell check and save inputted text.

• Child Welfare Licensing Form Request 

• Application for Child Care Plan Review - BFS-13 

• Court Operated Facility Rules Review Worksheets

• Child Caring Institution Rules Review Worksheets

• North American Indian Tribal Affiliation Verification - BCAL-0120A 

• Special Investigation Report - BCAL-259 

• Health History Record - OCAL-353 

• Original License Application Packet Adult Foster Care, Child Day Care, Child Caring Institution, or Child Placing Agency

• Child Caring Institution Application - BCAL-1074 

• Licensing Record Clearance Request - BCAL-1326-CC 

• Children's Foster Home Rules Compliance Record - BCAL-3080 

• Report of Actual or Suspected Child Abuse or Neglect - DHS-3200 

• Child Information Record - BCAL-3731 

• Child Information Record - BCAL-3731-AR (Arabic) 

• Documento de Información del Niño Estado de Michigan - BCAL-3731-SP 

• Foster Home Reference Questionnaire - OCAL-3739 

• Medical Emergency Care Authorization - OCAL-3978 

• Emergency Telephone Numbers - OCAL-4234 

• Incident, Accident, Illness, Death or Fire Report - BCAL-4603 

• Initial Relative Safety Screen - DHS-588 (Word)

• Waiver of Foster Home Licensure-Relative Caregiver - DHS-875 (Word)

• DHS-972 Relative Agreement for Placement and Licensure Rev 2/11

• Assistance Application (DHS-1171) A packet containing an application for assistance, an information booklet and a filing form. The best way to apply for assistance is online using MI Bridges. If you need to use this paper application, keep in mind that after you've completed the application, you will need to print it and take it to your local DHS office.

• Solicitud de Asistencia - DHS-1171-SP

• Irrevocable Funeral Contract Certification - DHS-8-A 

• Deductible Report - DHS-114A 

• Informe de Deducible - DHS-114A-SP 

• Plan First! Family Planning Program Application - MSA-1582 

• Solicitud Para Medicaid Retroactivo - DHS-3243-SP 

• Retroactive Medicaid Application - DHS-3243 

• Medicaid Application Patient of Nursing Home - DHS-4574 

• Asset Declaration Patient and Spouse - DHS-4574-B 

• Declaration De Bienes Paciente Y Esposo/A - DHS-4574-B-SP 

• Request for Hearing - DHS-18 

• Hearing Request Withdrawal - DHS-18-A 

• Certification of Translation for Non-English Speaking Applicants or Recipients - DHS-848 

• Request for Emergency Shelter Temporary Assistance for Needy Families (TANF) - DHS-3041-ES (PDF) - For homeless shelter providers ONLY 

• Voter Registration Application and Michigan Driver License/Personal Identification Card Address Change Form - NSP-0938-B 

• Solicitud de Registración del Votante y Licencia de Manejar de Michigan/Instrucciones de la Forma para Cambiar su Dirección en su Tarjeta de Identificación Personal - NSP-0938B-SP 

• Voluntary Medical Background Form - DHS-4819  If the surrendering parent wishes to provide information about their medical background, this information would assist with the newborn's care.

• Forma Voluntaria de Antecedentes Medicos para un Recien Nacido Entregado - DHS-4819-SP  La Forma Voluntaria de Antecedentes Médicos para un Recién Nacido Entregado es llenada por el Proveedor de Servicios de Emergencia.

• Voluntary Release for Adoption - DHS-4820  The Voluntary Release for Adoption of a Surrendered Newborn by Parent form is a written affirmation that the surrendering parent voluntary released their parental rights to their newborn child.

• Entega Voluntaria Para Adopcion De Un Recien Nacido Por Parte De Un Padre - DHS-4820-SP 

• Registration for Ongoing Volunteers - DHS-1182-A 

• Registration for Short Term Volunteers - DHS-1182-B 

• Registration for Group Volunteers - DHS-1182-C 

• Request for Central Registry - DHS-1929 (Word)