Forms

How do you apply?  
Applications may be submitted in-person at one of our 5 locations, online at ccssreferrals@clarkcountynv.gov or by fax at 702-678-5221.

Notice of Privacy Practices

Files below are fillable, for best results please download the file to your computer or phone and complete using an Adobe product. 

CCSS Application - English
Applications can be emailed to CCSSReferrals@ClarkCountyNV.gov, faxed to 702-678-5221 or mailed to CCSS 1600 Pinto Lane Las Vegas, NV 89106.

CCSS Application - Spanish     
Las solicitudes pueden enviarse por correo electrónico a CCSSReferrals@ClarkCountyNV.gov, por fax al 702-678-5221o enviarse por correo a CCSS 1600 Pinto Lane Las Vegas, NV 89106.

Long Term Care application

HHHA Referral

W9 to be filled out by Property Owner Please click here