Forms published to eDocs (March 2018)

Minnesota Department of Human Services sent this bulletin at 04/03/2018 08:37 AM CDT

Forms published to eDocs

March 2018

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-3141-ENG Variance Request

DHS-3799-ENG Child Foster Care Notice to Relatives

DHS-3912-ENG Community-Based Services (CBS) Program Referral Form

DHS-4106C-ENG Health plan enrollment form for people 65 years old or older

DHS-4122C-ENG IEP Services Personal Care Assistance Activities Checklist

DHS-4795-ENG Minnesota Child Care Assistance Programs Quality Differential Rate Request Form

DHS-5223F-ENG Supplemental Nutrition Assistance Program (SNAP) Application for Seniors (Individuals and couples age 60 and older)

DHS-6217A-ENG Child Care Assistance Notice of Decision - Service Authorization for families

DHS-6217B-ENG Child Care Assistance Notice of Decision - Service Authorization for providers

DHS-6633-ENG Exception to CDCS Budget Methodology

DHS-6791A-ENG MnCHOICES Community Support Plan Worksheet

DHS-7611A-ENG Person's evaluation of his or her coordinated service and supports plan (CSSP) (offline version)

DHS-7611B-ENG Person's evaluation of his or her service provider for day services (offline version)

DHS-7611C-ENG Person's evaluation of his or her service provider for non-day or non-residential services (offline version)

DHS-7611D-ENG Person's evaluation of his or her service provider for residential services (offline version)

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