Forms published to eDocs (March 2020)

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Forms published to eDocs

March 2020


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-3354C-ENG Managed Care Pre-enrollment Questionnaire

DHS-3428C-ENG Determination of Age-Appropriate Dependencies for Children who use Long-Term Care

DHS-4074A-ENG Personal Care Assistance (PCA) Technical Change Request

DHS-4209N-ENG Minnesota Family Investment Program (MFIP) education activity log

DHS-4206C-ENG Quarterly Outpatient Problem Gambling Service Report

DHS-4206D-ENG Quarterly Residential Problem Gambling Service Report

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

DHS-5207-ENG County agency address and phone number list

DHS-5504B-ENG Exception Request for Environmental Accessibility Adaptations that Exceed $40,000 (CAC, CADI, BI and DD Waivers)

DHS-5591-ENG Medical Assistance for People Who Are 65 Years Old or Older, Are Blind, or Have a Disability: Worker Checklist 

DHS-6020-ENG SNAP Employment and Training Plan

DHS-6801-ENG White Earth Nation Human Services Transfer Verification Form

DHS-6804-ENG CCAP Override Monitoring Form

DHS-7618-ENG Home and Community-Based Settings Applicant Assurance Statement

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

DHS-7953B-ENG Orientation Training Record - Licensed Child Care Centers

DHS-7994-ENG Personnel Information Form

DHS-7999-ENG Staffing Patterns

DHS-8026-ENG HCA Variance Request

DHS-8047-ENG Certification pre-application form


The following form(s) were made obsolete:


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