Notice of Privacy Practices

How do you apply?  

Applications may be submitted in-person at one of our 5 locations, online at or by fax at 702-678-5221.

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, 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, 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

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