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Please note that the following forms may have new web addresses. Web pages or other documents that link to these forms may need to be updated.
 DHS-1795A-ENG
Interim Assistance Agreement
DHS-2400-ENG
Authorization for Release of Information from the BCA
DHS-3335A-ENG
Fraud Prevention Investigation Referral
DHS-3918-ENG
Medical Assistance for Employed Persons with Disabilities (MA-EPD) Late Request for Medicare Part B Reimbursement
DHS-4138-ENG
Minnesota Department of Human Services Provider Agreement
DHS-4535-ENG
Augmentative Communication Devices and Accessories Authorization Form
DHS-4790-ENG
MNsure Assister Case Association Form
DHS-4795-ENG
CCAP Quality Differential Rate Request Form
DHS-5006I-ENG
2016 Earned Income/Pay Period/Date Tracking Form
DHS-5190-ENG
CCAP Licensed Provider Registration and Acknowledgement
DHS-5208A-ENG
MHCP Ground Ambulance Checklist
DHS-5212-ENG
Immunomodulator Drug Authorization Form
DHS-5275-ENG
Health plan notification of foster care and child protection placement with authorization form
DHS-5704B-ENG
Child/Adolescent Diagnostic Assessment - Part II
DHS-5924-ENG
Group Residential Housing (GRH) Supplemental Services – Provider Enrollment Application
DHS-6569-ENG
Application for Private Adoption Agency Staff to Request Membership on the Minnesota Adoption Email Listserv
DHS-6383-ENG
Home and Community Based Services (HCBS) Lead Agency Enrollment Request Form
DHS-6638-ENG
Service Request Form for HCBS Waiver, Alternative Care (AC), Moving Home Minnesota or Essential Community Supports
DHS-7097-ENG
Office of Inspector General Employer Insurance Verification Form
DHS-7181-ENG
Mental Health Adult Rehabilitative Mental Health Services (ARMHS) Provider Application
DHS-7181A-ENG
Mental Health Adult Rehabilitative Mental Health Services (ARMHS) Provider Certification Requirements
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