State-30 Program of Kansas

  Forms

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Notice of Intent to Apply – Form

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Assembly Submission Checklist

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State 30 J-1 Visa Waiver Program Affidavit and Agreement – Form

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U.S. Department of State Exchange Visitor Attestation – Form

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U.S. Department of State Employer Attestation – Form

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Kansas Physician/Employer Reporting – Form

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Kansas Transfer Notification Reporting – Form

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Kansas National Interest Wavier Request Reporting – Form

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Income Eligibility Guidelines and Discount Table

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Contact the Primary Care Office Director at (785) 296-2742 or email bhuske@kdheks.gov.