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DHS-2630-ENG Alternative Care Program Eligibility Worksheet for Unmarried Individuals or Married Couples when both May Choose the Alternative Care Program or a Married Person Whose Spouse is an EW Recipient or Living in a Nursing Facility
DHS-2630A-ENG Alternative Care Program Eligibility Worksheet for a Married Person who has a Community Spouse
DHS-3550-ENG Minnesota Child Care Assistance Program Application
DHS-3751-ENG Individual Community Living Support (ICLS) Planning Form
DHS-3769A-ENG Legally Nonlicensed (LNL)Provider Training Documentation Form
DHS-3769B-ENG License Exempt Provider Acknowledgment Form
DHS-3777A-ENG Immunizations status follow-up
DHS-3801-ENG Independant Living Plan
DHS-3956A-ENG Elderly Waiver CDCS Conversion Rate Request
DHS-4022C-ENG MHCP Qualified Professional (QP) Acknowledgement
DHS-4049-ENG MHCP Enrollment Application for Billing Intermediaries, Clearinghouses and EDI Trading Partners
DHS-4074A-ENG Personal Care Assistance (PCA) Technical Change Request
DHS-4106A-ENG Health plan enrollment form for people under 65
DHS-4106B-ENG Health plan enrollment form for non-disabled people under age 65
DHS-4122C-ENG IEP Services Personal Care Assistance Activities Checklist
DHS-4695-ENG MHCP Authorization Form
DHS-4740-ENG Minnesota Family Planning Program Application
DHS-4797B-ENG Behavioral Health Home (BHH) Services Rights, Responsibilities and Consent
DHS-5223D-ENG Combined Application - Child Care Addendum
DHS-5274-ENG Child Care Assistance Program Redetermination Form
DHS-5678-ENG Request for Resubmission Individual PCA Enrollment Application or Agreement
DHS-5678A-ENG Request for Resubmission Consumer Directed Community Support (CDCS) Enrollment Application or Agreement
DHS-6189Z-ENG Provider Not Required to Receive a 245D Program License Applicant Assurance Statement
DHS-6406-ENG MHCP SMAC Research Request Form
DHS-6683-ENG Essential Community Supports Program (ECS) Eligibility Worksheet for Unmarried Individuals, Married couples when both are requesting ECS, Married couples – spouse served under AC, EW or in a nursing home
DHS-6683A-ENG Essential Community Supports Program (ECS) Eligibility Worksheet for a Married Individual when only one spouse is requesting services
DHS-6810D-ENG Request for the Authorization of the Emergency Use of Procedures
DHS-6826-ENG Essential Community Supports Program (ECS) Financial Disclosure Form
DHS-7025-ENG Direct Care and Treatment Contract Evaluation
DHS-7109D-ENG EIDBI 60-Day Temporary Increase Request for Intervention Services
DHS-7176-ENG Home and Community-Based Services (HCBS) Provider Attestation
DHS-7176A-ENG HCBS Provider Attestation Hardship Extension Request
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