Forms

Click on a link below to view and print our current participant forms.

list-checkmarkApplication
Print out paper application to complete and mail or fax to the HIBI Program.

 

list-checkmark Renewal Application Form
Fill out a renewal form to apply for continued program participation and to avoid any interruption in your monthly payments.
Sign up for direct deposit payments. It is easy to sign up and you will not have to wait for your check to arrive by mail.

 

list-checkmarkInformation Change Form
Keep your personal information up-to-date. It is especially important to keep your banking account, mailing address, commercial health insurance policy information, and Medicaid status up-to-date.

 

list-checkmarkConsent Form
Allow a representative, such as a family member, to speak on your behalf or have access to your health information.

 

list-checkmarkDirect Deposit Form
Print out a Direct Deposit form.

 

list-checkmarkFax Cover Sheet
Use this cover sheet to fax your forms to the Colorado HIBI Program.

 

Learn more about continuing your eligibility.

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