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Reports & Publications

To find information related to certification and licensing for home and community based services programs, behavioral health programs, substance abuse treatment programs, therapeutic communities, residential care facilities, partial hospitalization, and assisted living facilities, please visit: https://humanservices.arkansas.gov/about-dhs/dpsqa/provider-resources.

Block Grant

Title Type Posted Date
FFY 2021 SAMH Mini Block Grant Behavioral Health Assessment and Plan application PDF 08/17/2020
FFY 2020 MHBG Annual Report PDF 12/17/2019
FFY 2020 SABG Annual Report PDF 12/17/2019
FFY2020 Combined SA/MH Application with Notice for Comment PDF 07/30/2019
2019 SABG Annual Report PDF 06/12/2019

Brochures

Title Type Posted Date
Senior Medicaid Patrol Brochure PDF 05/08/2019
Diabetes Brochure PDF
MDS Section Q Brochure PDF
Diabetes Brochure - Spanish PDF

Directories

Title Type Posted Date
DASEP DWI County Directory DOC 08/20/2020
DASEP DWI Staff Directory PDF 07/15/2020
SFY20 Arkansas Prevention Services Providers List PDF 12/12/2019
Community Mental Health Center Directory PDF 08/22/2019
Licensed Substance Abuse Treatment Providers PDF 08/02/2018

Forms

Title Type Posted Date
AAS-9511 Change of Client Status Form PDF 08/01/2019
24 Hour Contact Information Form PDF 05/12/2019
DHS-4000 Authorized to Disclose Health Info-Release of Info Form PDF 05/11/2019
DHS-4000 Release of Info Authorization - Spanish Edition PDF 05/11/2019
DHS-8504 Start Service Form PDF 05/10/2019
DHS-8505 Informed Consent PDF 05/09/2019
DHS-8506 MFP Assessment and Personal History Form PDF 05/08/2019
DHS-8507 Checklist of Clients Rights Form PDF 05/07/2019
DHS-8508 Statement of Rights & Responsibilities of MFP Participants Form PDF 05/06/2019
DHS-8510 Demonstration Services Freedom of Choice Form PDF 05/05/2019
DHS-8511 Transition Risk Plan Form PDF 05/04/2019
DHS-8512 Risk Mitigation Monthly Form PDF 05/03/2019
DHS-8520 General Professional Recommendations Form PDF 05/02/2019
DHS-8521 Demonstration Services Plan of Care Form PDF 05/01/2019
DHS-8523 Housing Information Form PDF 04/30/2019
MediMaide Checklist (Need copy of Prescriptions) Form PDF 04/29/2019
Consent to Discuss Form PDF 04/28/2019
Tier Level Request Form PDF 04/27/2019
Transition Goods and Services Form PDF 04/26/2019
Helping Hands Respite Programs form PDF 02/19/2019
APS-0001 Request for Adult Maltreatment Registry Information DOC 09/12/2016

General Information

Title Type Posted Date
Arkansas Money Follows the Person Demonstration Operational Protocol PDF 01/30/2014
DASEP Guidelines PDF 10/30/2012

Manuals

Title Type Posted Date
Deaf Mental Health Certification Manual 08/25/2020
Infant Mental Health Therapist Provider Training PDF 08/25/2020
Infant Mental Health Therapist Standards Manual with application 09.06.19 PDF 08/20/2020
Regional Alcohol and Drug Detoxification (RADD) Manual 2020 PDF 03/02/2020
Licensure Standards for Alcohol and other Drug Abuse Treatment Programs PDF 04/26/2019

Procedures

Title Type Posted Date
Provider Reconsideration Submission Instructions PDF 03/28/2019
Provider Reconsideration Registration Instructions PDF 03/28/2019

Reports

Title Type Posted Date
Adult Protective Services (APS) Taskforce Report PDF

Resources

Title Type Posted Date
Senior Medicaid Patrol Brochure PDF 05/08/2019
Dealing with the Effects of Trauma PDF
DAABHS Infant Mental Health PDF

Rules

Title Type Posted Date
HIPAA Notice of Privacy Practices PDF 10/13/2010

State Plan

Title Type Posted Date
Aging State Plan - Fiscal 2020 - 2022 PDF 08/31/2020

Synar Report

Title Type Posted Date
2020 Arkansas Annual Synar Report PDF 12/13/2019
2019 Arkansas Annual Synar Report PDF 06/27/2019
2018 Arkansas Annual Synar Report PDF 11/08/2017
2017 Arkansas Annual Synar Report PDF 11/06/2016
2015 Arkansas Annual Synar Report PDF 12/09/2015
2016 Arkansas Annual Synar Report PDF 12/08/2015
2014 Arkansas Annual Synar Report PDF 10/16/2014
2013 Arkansas Annual Synar Report PDF 01/24/2013
2012 Arkansas Annual Synar Report PDF 11/29/2011
Arkansas Department of Human Services
Arkansas Department of Human Services

Arkansas Department
of Human Services
(501) 682-1001

TTY: 1-800-285-1131 or dial 711 for Arkansas Relay Service

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