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This document is used to report incidents resulting in death, serious injury, or illness at swimming pools and water attractions, requiring emergency medical assistance.
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How to fill out HFS 172
01
Start by downloading the HFS 172 form from the official website or obtain it from your local office.
02
Read the instructions carefully before beginning to fill out the form.
03
Fill in your personal information such as name, address, and contact details in the designated sections.
04
Provide any required identifiers, such as Social Security Number or case number, if applicable.
05
Complete the financial information section as instructed, ensuring all figures are accurate.
06
Review the form for completeness and correctness.
07
Sign and date the form in the provided area.
08
Submit the form via the specified method, either by mail or electronically, depending on the guidelines.
Who needs HFS 172?
01
Individuals or families applying for financial assistance or benefits.
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People seeking support through state or government health programs.
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Residents who need to document their eligibility for housing or social services.
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Anyone who has been instructed by a state agency to complete the form.
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What is HFS 172?
HFS 172 is a specific form used for filing certain financial or compliance information in accordance with state regulations.
Who is required to file HFS 172?
Entities and organizations that are required to report specific financial data or compliance information, as dictated by state regulations, must file HFS 172.
How to fill out HFS 172?
To fill out HFS 172, follow the instructions provided with the form, ensuring all required sections are completed accurately and supported by necessary documentation.
What is the purpose of HFS 172?
The purpose of HFS 172 is to collect data and information necessary for regulatory compliance and oversight by state authorities.
What information must be reported on HFS 172?
The information that must be reported on HFS 172 typically includes financial statements, operational data, and any compliance-related information as outlined in the form's instructions.
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