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DHS-2977-ENG Important Notice and Parental Fee Worksheet
DHS-3159-ENG Minnesota Voluntary Recognition of Parentage
DHS-3418-ENG Minnesota Health Care Programs Renewal
DHS-3426-ENG OBRA Level I Criteria – Screening for Developmental Disabilities or Mental Illness
DHS-3428Q-ENG Person's Evaluation of Foster Care, Customized Living, or Adult Day Service
DHS-3767-ENG Request for Group Health Plan Information
DHS-3767A-ENG Request for Employee's Group Health Plan Information
DHS-3767B-ENG Request for Individual Health Plan Information
DHS-3767C-ENG Request for Policyholder's Insurance Information
DHS-3767D-ENG Determination of Cost Effectiveness
DHS-3767E-ENG Your Health Insurance Is Cost Effective
DHS-3767F-ENG Your Health Insurance Is Not Cost Effective
DHS-3767G-ENG Application for a Good Cause Waiver
DHS-3767H-ENG Determination for a Good Cause Waiver
DHS-3876-ENG MHCP Application for Certain Populations
DHS-4005-ENG TED Application
DHS-4929-ENG Disability Services Division: Caregiver Living Expenses Worksheet
DHS-6355-ENG DHS Foster Care Candidacy Statistical Report
DHS-6634-ENG Title IV-E Checklist
DHS-6683-ENG Essential Community Supports Program (ECS) Financial 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-6790L-ENG Rate Management Worksheet - Employment Services
DHS-6810D-ENG Request for the Authorization of the Emergency Use of Procedures
DHS-7654-ENG DSD Employment Mentor Inquiry Form
DHS-7656-ENG Credit Reporting Direct Dispute-Claim Form
DHS-7666-ENG Psychiatric Residential Treatment Facility (PRTF) Individual Plan of Care and Authorization
DHS-7689-ENG Critical Access Mental Health Applicant Assurance Statement
The following form(s) were made obsolete:
DHS-3767I-ENG Hardship Determination for Cost-Effective Health Insurance
DHS-3767J-ENG Agency Appeals Summary for Cost-Effective Health Insurance (CEHI)
DHS-7169-ENG Performance Management System Performance Improvement Plans for Measures with Small Denominators
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