Professional Licensing Agency

State of Indiana

Official Website: https://www.in.gov/core/find_agency.html#pla

Forms & Documents

Browse all Professional Licensing Agency government forms

81 - 100 of 206 forms

Form Title Topics
GSD-06 General Source Data - Particulate Emissions
GSD-07 General Source Data - Criteria Pollutant Emissions Summary
GSD-08 General Source Data - Hazardous Air Pollutant Emissions Summary
GSD-09 General Source Data - Summary of Additional Information
GSD-10 General Source Data - Insignificant Activity
GSD-11 General Source Data - Alternative Operating Scenario Summary
GSD-12 General Source Data - Affidavit of Non-applicability
GSD-13 General Source Data - Affidavit of Applicability
GSD-14 General Source Data - Owners and Occupants Notified
GSD-15 General Source Data - Government Officials Notified
Hospice Authorization Notice for Dually Eligible Medicare/Medicaid Nursing Facility Residents Form
Hospice Provider Change Request Between Indiana Hospice Providers Form
IHCP Dental Prior Authorization Request Form
IHCP Dental Prior Authorization Request Form Instructions
IHCP Electronic Funds Transfer Addendum/Maintenance Form
IHCP Fast Track Notification Form
IHCP Full Eligibility Notification Form
IHCP Initial Assessment Form for Substance Use Disorder (SUD) Treatment Admission
IHCP Institutional and Inpatient/Outpatient Crossover Adjustment Request
IHCP Prior Authorization Request Form Instructions (universal PA form - instructions)

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