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The Ogden ORS location will be closed for the rest of the day due to no air conditioning. We apologize for the inconvenience.

Medicaid Recovery Forms

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  3. Medicaid Recovery Forms

The following forms are available for you to print and complete. If you have questions about which form you need to complete, please contact us.

MINQ Injury/Accident Questionnaire

This form gives us information about an accident or injury.

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Headquarters
Multi-Agency State Office Building
195 North 1950 West
Salt Lake City, Ut 84116

Child Support Contact Info

Call: +1 (801) 536-8500
Central Fax: +1 (801) 536-8636
Email: orswebcss@utah.gov

Medicaid Recovery Contact Info

Call: +1 (801) 536-8798
Central Fax: +1 (801) 536-0377
Email: orswebbmc@utah.gov

Resources
211Utah - United Way
Safe UT

  • Child Support
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Hotlines
Abuse/Neglect of Seniors and Adults with Disabilities
1-800-371-7897

Child Abuse/Neglect
1-855-323-DCFS(3237)

Crisis Line & Mobile Outreach Team
1-801-587-3000

National Suicide Prevention Lifeline
1-800-273-TALK(8255)

Sexual Violence Crisis Line
1-888-421-1100

Utah Domestic Violence
1-800-897-LINK(5465)

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  • Child Support
    • Manage Your Case
      • Manage Your Case
      • ORS Now
      • Apply for Child Support
      • Receive Child Support
      • Pay Child Support
      • Change a Child Support Order
      • Housing Verification
    • Our Process
      • Our Process
      • Establish Child Support Orders
      • Establish Paternity
      • Set and Enforce Medical Support
      • Locate Parents
      • Collect Child Support
      • Case Closure
    • Calculate Support
      • Calculate Support
      • Calculate Child Support
    • Professional Services
      • Professional Services
      • Employer Services
      • FIDM
    • Resources
      • Resources
      • Forms
      • Glossary
      • Public Policy
      • Statistics
    • Contact
      • Contact
      • News and Announcements
  • Medicaid Recovery
    • Programs
      • Programs
      • Estate Recovery
      • TORT
      • Healthcare Claims
    • Resources
      • Resources
      • Forms
      • Glossary
      • Statistics
    • Contact
      • Contact
      • News and Announcements
  • News
  • Contact
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