Request for STAC Forms

The following STAC forms are available in PDF format. Click on the form link below.


The STAC-200s are five-part forms. To request hard copies of these forms please contact the STAC and Medicaid Unit by phone (518) 474-7116, fax (518) 402-5047 or email omsstac@mail.nysed.gov.

Last Updated: April 12, 2017