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DHS-3471B-ENG Brain Injury (BI) Waiver Eligibility and Documentation Checklist
DHS-3525B-ENG Temporary Medical Assistance Authorization
DHS-3548-ENG Alternative Care Program Client Disclosure Form
DHS-3550-ENG Minnesota Child Care Assistance Program Application
DHS-3745-ENG Licensed Child Care Center Application
DHS-4209N-ENG Minnesota Family Investment Program (MFIP) education activity log
DHS-4457-ENG Request for Department Resolution of Financial Responsibility Dispute
DHS-4571-ENG Interim Assistance Payment Request
DHS-5186-ENG Alternative Care Program Estate Recovery Information
DHS-5271-ENG Experienced Aide Report
DHS-6020-ENG Supplemental Nutrition Assistance Program (SNAP) Employment and Training Plan
DHS-6321-ENG Human Services Performance Management System Claim for Extenuating Circumstances
DHS-6790L-ENG Rate Management Worksheet - Employment Services
DHS-7016-ENG State of Minnesota Workforce Certificate Information
DHS-7108A-ENG EIDBI Comprehensive Multi-Disciplinary Evaluation (CMDE) Medical Necessity Summary Information Signature Form (Addendum B)
DHS-7120A-ENG EIDBI Assurance Statement for Comprehensive Multi-Disciplinary Evaluation (CMDE) Providers
DHS-7120B-ENG Assurance Statement for EIDBI Provider Agencies
DHS-7120D-ENG EIDBI Assurance Statement for Level I Providers
DHS-7120E-ENG EIDBI Assurance Statement for Level II Providers
DHS-7168-ENG Performance Management System Performance Improvement Plans
DHS-7176H-ENG HCBS Rights Modification Support Plan Attachment
DHS-7192-ENG We Have Denied Your Request to Change Your Health Plan
DHS-7645A-ENG EIDBI Benefit: Your rights and responsibilities (draft for public comment)
DHS-7645B-ENG EIDBI Benefit: Provider agency rights and responsibilities (draft for public comment)
DHS-7666-ENG Psychiatric Residential Treatment Facility (PRTF) Individual Plan of Care and Authorization
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