Corrections are marked with ***

DHS-0029G-ENG MHCP Medical Assistance for Families with Children and Adults (MA-FCA) Income Eligibility

DHS-2414-ENG Notice of Late or Incomplete Household Report Form, Health Care Renewal Form or Combined Six-Month Report or Recertification

DHS-2807-ENG Civil Rights Complaint Form: Discrimination in Service Delivery

DHS-3131A-ENG CCAP Provider Notice of Intentional Program Violation - Waiver of ADH

DHS-3163B-ENG Referral to support and collections

DHS-3403-ENG Minnesota Health Care Programs Fee-for-Service Coverage

DHS-3436-ENG Request for Investigative Subpoena

DHS-3876-ENG MHCP Application for Certain Populations

DHS-3926-ENG Request for guidance on agency error overpayment

DHS-4005-ENG Telephone Equipment Program Application

DHS-4145-ENG County Notice of IMD Status

DHS-4382-ENG New or Expanding Adult Day Treatment (ADT) Service Application

DHS-5223C-ENG Combined Application - Addendum (For SNAP (food) and cash assistance programs)

***DHS-5576A-ENG Combined Six Month Report - Supplement for cash programs

DHS-5576B-ENG Combined Six-Month Report Cover Letter

***DHS-5815-ENG Alternative Care Program (AC) Application for Discretionary Services July 1-June 30 FY

DHS-6633A-ENG CDCS Community Support Plan Addendum with 2019 Budget Increase

DHS-6804-ENG CCAP Override Monitoring Form

DHS-6811-ENG Child Care Provider Investigations Communication Form

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

DHS-7823-ENG Authorization to Obtain Financial Information from the Account Validation Service (AVS) 

DHS-7967-ENG Housing Transition and Housing Sustaining Applicant Assurance Statement

DHS-7968-ENG Housing Consultation Providers Applicant Assurance Statement