Forms published to eDocs (February 2021) Minnesota Department of Human Services sent this bulletin at 03/01/2021 08:42 AM CST Forms published to eDocs February 2021 DHS-1958-ENG Application for child support services (Paper) DHS-1958-ENG Application for child support services (Online) DHS-3354F-ENG Annual Health Plan Selection Has Ended - managed care letter DHS-3525-ENG Minnesota Health Care Programs Application and Renewal Form for Medical Assistance for Women with Breast or Cervical Cancer (MA-BC) DHS-3550-ENG Minnesota Child Care Assistance Program Application DHS-3767D-ENG Determination of Cost Effectiveness DHS-3767E-SPA Your Health Insurance Is Cost Effective - Spanish DHS-3767F-SPA Your Health Insurance Is Not Cost Effective - Spanish DHS-4022A-ENG MHCP PCPO Provider Agreement Addendum DHS-4022B-ENG PCA Choice Provider Agreement DHS-4022C-ENG MHCP Qualified Professional (QP) Acknowledgement DHS-4087-ENG Electronic Remittance Advice (RA) Request DHS-4138-ENG MHCP Provider Agreement DHS-4224-ENG ICF/DD Training and Habilitation Agreement DHS-4258D-ENG Minnesota Adoption and Child Foster Care Home Study Assessment DHS-4258E-ENG Minnesota Adoption and Child Foster Care Home Study Assessment Update DHS-4611-ENG MHCP Individual Support Worker (CDCS, CSG, PCA, CFSS) Provider Agreement DHS-4611A-ENG MHCP Individual Non-Pay-To Provider Agreement DHS-4611B-ENG MHCP Volunteer Dentists Provider Agreement DHS-4646-ENG MHCP Child and Teen Checkups (C&TC) Provider Agreement Addendum DHS-4677F-ENG ICF/DD Services During the Day Option DHS-4681A-ENG Summary of Personnel Information - Certified Child Care Centers DHS-4719-ENG Guidelines for developing policies and procedures DHS-4786-ENG MHCP Sage and Screen Our Circle Screening Programs Medical Assistance (MA) Presumptive Eligibility Agreement DHS-5223D-ENG Combined Application - Child Care Addendum DHS-6790M-ENG RMS Worksheet – Day and Employment Services DHS-6810-ENG Positive Support Transition Plan DHS-6910-ENG RMS User Manual: Residential Shared Staffing Hours Worksheet DHS-6910O-ENG RMS: Integrated Community Supports (ICS) Individual Staffing Hours Worksheet DHS-7002-ENG Financial Management Services (FMS) – Provider Agreement Addendum for CFSS, CDCS and CSG Services DHS-7120B-ENG Early Intensive Developmental and Behavioral Intervention (EIDBI) Provider Assurance Statement DHS-7307-ENG Housing Focused Person-Centered Plan DHS-7325-ENG 1115 Substance Use Disorder System Reform Enrollment Checklist DHS-7336-ENG MHCP Accident Injury Report DHS-7340-ENG Officer-Involved Community-Based Care Coordination Assurance Statement DHS-7953B-ENG Orientation Training Record - Licensed Child Care Centers DHS-7967-ENG Housing Transition and Housing Sustaining Provider Assurance Statement DHS-7968-ENG Housing Consultation Provider Assurance Statement DHS-8056-ENG Deaf and Hard of Hearing Services Division Permission to Share Information DHS-8057-ENG Deaf and Hard of Hearing Services Division Client Intake Form DHS-8068-ENG Sibling Bill of Rights Commissioner's Form The following form(s) were made obsolete: None 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. If you have questions, contact the eDocs Helpdesk. In order to view PDF forms on eDocs, download the latest FREE version of Adobe Reader.