Lead agencies should start using the My Move Plan Summary (DHS-3936)

Minnesota Department of Human Services

Disability Services Division eList


July 14, 2016

TO: Case managers, support planners and other interested stakeholders
FROM:  DHS Aging and Adult Services and Disability Services divisions
EFFECTIVE: Immediately
PURPOSE: To announce the release of the My Move Plan Summary (DHS-3936) in eDocs 
CONTACT: DSD.ResponseCenter@state.mn.us

Lead agencies should start using the My Move Plan Summary (DHS-3936)

To help with the process of moving, DHS created the My Move Plan Summary, DHS-3936-ENG (PDF) to support people with disabilities, including people with mental illness and people who use long-term supports and services. The summary is a written agreement that:

  • Helps to clarify roles expectations before, during and after the move
  • Helps make the move successful as it clearly communicates all of the key elements of the plan.


The Person-Centered, Informed Choice and Transition Protocol (PDF) requires lead agencies, specifically case managers and support planners, to work together with the person who is moving to create this summary.

Lead agency roles and responsibilities

When using the My Move Plan Summary, the lead agency (e.g., support planner, case manager, etc.) should:

  • Initiate the document’s creation
  • Build and share the summary with the person
  • Inform the person about the process, including any changes to the plan
  • Refer to the document throughout the move
  • Update the document when it needs modification or changes
  • Sign and keep a copy of the completed document in the person’s file.

For more specific information about lead agency responsibilities, see Page 16 of the protocol (PDF).

More information

DHS is in the process of developing online person-centered practices content to support lead agency staff. It will be available soon, and we will alert you when it is ready.

In the meantime, to view transition requirements, view Bulletin #16-56-02: Lead Agency Requirements for Person-Centered Principles and Practices – Part 2 (PDF).