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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-0029C-ENG Elderly, Disabled and Blind Income Computation Worksheet - Method B
DHS-2630A-ENG Alternative Care Program Eligibility Worksheet for a Married Person who has a Community Spouse
DHS-2727-ENG Long-Term Services and Supports Assessment and Program Information and Signature Sheet
DHS-2776E-ENG Collectible/Non-Collectible Agency Error Overpayment Worksheet
DHS-3244P-ENG Referral for Reassessment for PCA services
DHS-3340B-ENG MHCP Requested Asset Assessment Results
DHS-3340C-ENG MHCP Designation of Assets
DHS-3340E-ENG Asset Assessment Results for Current HCBS Waiver Enrollee
DHS-3340F-ENG Asset Assessment Request for Information for Current HCBS Waiver Enrollee
DHS-3428A-ENG Minnesota Long Term Care Consultation Services Assessment Form: SW Section
DHS-3550-ENG Minnesota Child Care Assistance Program Application
DHS-3959-ENG Important Information – Health Care Coverage Options
DHS-4016A-ENG MHCP Organization - Provider Enrollment Application
DHS-4292-ENG PCA Request Fax Form
DHS-4677C-ENG ICF/DD Local System Needs Plan Amendment
DHS-4691-ENG PCA Time and Activity Documentation
DHS-5085A-ENG IEP/IFSP Evaluation Documentation Log
DHS-5178-ENG Emergency Relative Placement Foster Care Referral Form
DHS-5212-ENG Immunomodulator Drug Authorization Form
DHS-5223D-ENG Combined Application - Child Care Addendum
DHS-5274-ENG Child Care Assistance Program Redetermination Form
DHS-6219-ENG Title 3E Caregiver Assessment Questionnaire
DHS-6381-ENG CCDTF Residential and Inpatient Assurance Statement
DHS-6382-ENG CCDTF Outpatient Services Assurance Statement
DHS-6552-ENG DeafBlind Consumer Directed Services - Service and Budget Agreement
DHS-6562-ENG Deaf and Hard of Hearing Services Advisory Committee Application
DHS-6715-ENG Protected Transport - Level-of-Service (LOS) Assessment
DHS-6939-ENG MA-EPD Good Cause Application
DHS-7047-ENG State-Administered Nonemergency Medical Transportation (NEMT) Trip Sheet
DHS-7177-ENG Human Services Performance Council Application
DHS-7227-ENG Applicant Assurance Statement - Pharmacy Retrospective Billing
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