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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-1958-ENG Full Child Support (IV-D) Services Application and Information on Child Support
DHS-2133-ENG Request for an MHCP Member's Claims History
DHS-2841A-ENG Cost-Effective Insurance Calculation
DHS-2977-ENG Important Notice and Parental Fee Worksheet
DHS-2981-ENG Medical Assistance Parental Fee Form
DHS-3340-ENG Asset Assessment for Medical Assistance for Long-Term-Care Services (MA-LTC)
DHS-3427-ENG LTC Screening Document - AC, BI, CAC, CADI, ECS, EW, MHM, MSC+, MSHO, SNBC
DHS-3428-ENG Minnesota Long Term Care Consultation Services Assessment Form
DHS-3909-ENG Proposal to Conduct Research on DHS Program Participants – Application for IRB Review
DHS-3936-ENG My Move Plan Summary
DHS-4044B-ENG DHS Car Rental Form
DHS-4258C-ENG Minnesota Adoption and Foster Care - Home Study Agency Process Checklist
DHS-4296-ENG General Consent/Authorization for Release of Information
DHS-4797-ENG Determination of Eligibility for Behavioral Health Home (BHH) Services
DHS-4931-ENG Unreimbursed and/or Uninsured Medical/Dental Expenses Packet
DHS-5339-ENG Education and Training Voucher Program (ETV) Application and Renewal
DHS-5339A-ENG Education and Training Voucher Program (ETV) Verification of Eligibility
DHS-5815-ENG Alternative Care (AC) Application for Discretionary Services
DHS-5924-ENG Group Residential Housing (GRH) Supplemental Services – Provider Enrollment Application
DHS-6019-ENG Medical Modification Information Sheet
DHS-6021-ENG Request to Close or Develop New Corporate Foster Care (and Community Residential Settings)
DHS-6069B-ENG Child/Adolescent Diagnostic Verification Form
DHS-6218-ENG Housing Access Coordination Exception Request for people with criminal, subpar credit or eviction history
DHS-6249-ENG LOCUS Recording Form
DHS-6532-ENG CDCS Community Support Plan
DHS-6633-ENG Exception to CDCS Budget Methodology
DHS-6633A-ENG CDCS Community Support Plan Addendum with 2016 Provider Rate Increase
DHS-6715-ENG Protected Transport - Level-of-Service (LOS) Assessment
DHS-6762B-ENG Emergency Adult Protective Services (EPS) Structured Decision Making Tool EPS Intake Assessment Screening Decision Tool Form
DHS-6762C-ENG Adult Protection Structured Decision Making Safety Plan to Address Current Danger Factors
DHS-6762D-ENG Adult Protection SDM Strengths and needs Assessment/reassessment
DHS-6790J-ENG RMS Worksheet - DTH-Daily
DHS-6801-ENG White Earth Nation Human Services Transfer Verification Form
DHS-6804-ENG CCAP Override Monitoring Form
DHS-7197-ENG Corrective Action Form - CCAP Case Review
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