Forms published to eDocs (May 2020) Minnesota Department of Human Services sent this bulletin at 06/01/2020 08:00 AM CDT Forms published to eDocs May 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-1795-ENG SSI Interim Assistance Authorization DHS-4074-ENG MA Home Care Technical Change Request DHS-4795-ENG Minnesota Child Care Assistance Programs Quality Differential Rate Request Form DHS-4797-ENG Notification of Eligibility for Behavioral Health Home (BHH) Services DHS-5190-ENG Minnesota Child Care Assistance Programs Licensed Center Provider Registration and Acknowledgment DHS-5191-ENG Minnesota Child Care Assistance Programs License Exempt Provider Registration and Acknowledgment DHS-5192-ENG Minnesota Child Care Assistance Programs Legal Nonlicensed Provider Registration and Acknowledgment DHS-6451-ENG Special Needs BasicCare (SNBC) Choice Form DHS-6562-ENG Advisory Committee Application Form DHS-6633B-ENG CDCS Enhanced Budget Request and Community Support Plan Addendum DHS-7108A-ENG EIDBI Comprehensive Multi-Disciplinary Evaluation (CMDE) Medical Necessity Summary Information Signature Form (Addendum A) DHS-7195-ENG Licensed Family Child Care Provider Registration and Acknowledgment DHS-7307-ENG Housing Stabilization Services, Housing Focused Person-Centered Plan DHS-7309-ENG Patient Referral Arrangement Agreement DHS-7310-ENG Application for MA Coverage for COVID-19 Testing DHS-7313-ENG COVID-19 Notification of Operation of Alternative Adult Day Services DHS-7316-ENG RPO Verbal attestation of eligible status DHS-7317-ENG RPO Tennessen warning and verbal consent DHS-7754-ENG Substance Use Disorder (SUD) Provider Assurance Statement - Professionals DHS-8047-ENG Certification pre-application form The following form(s) were made obsolete: DHS-3134A-ENG - Child Care Assistance Program (CCAP) Notice of Program Disqualification for CCAP Providers If you have questions, contact the eDocs Helpdesk. In order to view PDF forms on eDocs, download the latest FREE version of Adobe Reader.