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 Is Living in a Nursing Facility
DHS-2630A-ENG Alternative Care Program Eligibility Worksheet for a Married Person who has a Community Spouse
DHS-2981-ENG Medical Assistance Parental Fee Form
DHS-3141-ENG Variance Request
DHS-3159B-ENG Minnesota Voluntary Recognition of Parentage Revocation Form
DHS-3159C-ENG Minnesota Voluntary Recognition of Parentage Spouse's Non-Parentage Statement
DHS-3159E-ENG Minnesota's Spouse's Non-parentage Statement Revocation Form
DHS-3426-ENG OBRA Level I Criteria – Screening for Developmental Disabilities or Mental Illness
DHS-3427-ENG LTC Screening Document - AC, BI, CAC, CADI, ECS, EW, MHM, MSC+, MSHO
DHS-3427H-ENG Health Risk Assessment Screening Document - MSC+, MSHO and SNBC
DHS-3427T-ENG LTC Screening Document - Telephone Screening
DHS-3428G-ENG Minnesota Service Change Form for EW and AC Participants
DHS-3428H-ENG Minnesota Health Risk Assessment Form
DHS-3548-ENG Alternative Care Program Client Disclosure Form
DHS-3767D-ENG Determination of Cost Effectiveness
DHS-3767E-ENG Your Health Insurance Is Cost Effective
DHS-4005-ENG TED Application
DHS-4679-ENG Staffing Patterns
DHS-5085-ENG Individualized Education Plan (IEP) and Individualized Family Service Plan (IFSP) Services Documentation Log
DHS-5274-ENG Minnesota Child Care Assistance Program Redetermination Form
DHS-6355-ENG DHS Foster Care Candidacy Statistical Report
DHS-6638-ENG HCBS Programs Service Request Form
DHS-7219-ENG Infant Rolling Over Parent Statement for Infant Less Than Six Months Old
DHS-7695-ENG Psychiatric Residential Treatment Facility (PRTF) Extended Leave Request
DHS-7736-ENG Allergy Information Form
DHS-7738-ENG Emergency Phone Numbers
DHS-7741-ENG Liability Insurance Notice to Parents or Guardians
DHS-7743-ENG Monthly Crib Inspection Form
DHS-7744-ENG New Licensing Requirements and Technical Assistance Checklist
DHS-7745-ENG Poisonous Plants Family Child Care
DHS-7746-ENG Prescription and Non-Prescription Medication Administration Permission
DHS-7747-ENG Rule and Statute Summary
DHS-7748-ENG Storm and Fire Drill
DHS-7749A-ENG Swimming Pool Permission
The following form(s) were made obsolete:
DHS-3769B-ENG License Exempt Provider Acknowledgment Form
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