Forms published to eDocs (February 2021)

Minnesota Department of Human Services logo

Forms published to eDocs

February 2021

eDocs

 

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


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