Forms published to eDocs (September 2018)

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Forms published to eDocs

September 2018

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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-3747-ENG Individualized Home Supports Provider Applicant Assurance Statement

DHS-3803-ENG SUID & AHT off Year Video Training Verification

DHS-3834-ENG SNP NF Service Authorization Template

DHS-4929-ENG Disability Services Division: Caregiver Living Expenses Worksheet

DHS-5190-ENG Minnesota Child Care Assistance Programs Licensed Center Provider Registration and Acknowledgment

DHS-5192-ENG Minnesota Child Care Assistance Programs Legal Nonlicensed Provider Registration and Acknowledgment

DHS-5192D-ENG CCAP Legal Nonlicensed Provider Local Emergency Contacts

DHS-5588-ENG Child Care Assistance Notice of Decision - Denial

DHS-6037-ENG HCBS Waiver, AC, and ECS Case Management Transfer and Communication Form

DHS-6451-ENG Special Needs BasicCare (SNBC) Choice Form

DHS-7680-ENG Child Care Assistance Program (CCAP) Primary and Secondary Provider Report Form

DHS-7696-ENG Psychiatric Residential Treatment Facility (PRTF) Eligibility for Admission

DHS-7706-ENG Remote Support - Supported Living Services Provider Applicant Assurance Statement

DHS-7773-ENG Travel and Activity Authorization

DHS-7774-ENG Serious Injury Reporting Form - Family Child Care

DHS-7776-ENG Admission and Arrangements - Family Child Care

DHS-7779-ENG Preliminary Information Form - Family Child Care


The following form(s) were made obsolete:

None


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