Forms published to eDocs (June 2021) Minnesota Department of Human Services sent this bulletin at 06/30/2021 07:25 PM CDT Forms published to eDocs June 2021 DHS-2638-ENG Day Training and Habilitation Service Agreement DHS-2776C-ENG Computation of DWP Overpayment Worksheet DHS-2978-ENG MHCP Medical Referral for MRRP Enrollee DHS-2981-ENG Medical Assistance Parental Fee Form DHS-2981-SPA Medical Assistance Parental Fee Form - Spanish DHS-3274-ENG DHS Request for Approval to Incur Special Expenses Form DHS-3491-ENG Behavioral Health Fund (BHF) Provider Assurance Statement DHS-3535A-ENG MHCP Organization Provider Profile Change Form DHS-4005-ENG Telephone Equipment Distribution Program Application DHS-4005C-ENG Telephone Equipment Distribution Program Consent to release information DHS-4533-ENG Get Your Child Support Payments Faster, Safer, Easier DHS-4533-HMN Get Your Child Support Payments Faster, Safer, Easier - Hmong DHS-4533-SOM Get Your Child Support Payments Faster, Safer, Easier - Somali DHS-4533-SPA Get Your Child Support Payments Faster, Safer, Easier - Spanish DHS-4960A-ENG Determination of need application to expand day services DHS-4960B-ENG Determination of need application for proprietary changes, reductions and closures to day services DHS-5107-ENG Administration of the Child Care Assistance Program - 2022 - 2023 County and Tribal Child Care Fund Plan DHS-5588A-ENG Child Care Assistance Notice of Decision - Termination DHS-5820-ENG Disability Waiver Rates System Exception Request DHS-6381-ENG Residential or Inpatient Behavioral Health Fund (BHF) Service Request DHS-6382-ENG Outpatient Behavioral Health Fund (BHF) Service Request DHS-6759H-ENG Moving Home Minnesota Communication Form (Incoming) DHS-6810D-ENG Request for the Authorization of the Emergency Use of Procedures DHS-6811-ENG Child Care Provider Investigations Communication Form DHS-7019-ENG Exceptions to Terms and Conditions Formd DHS-7108-ENG CMDE Medical Necessity Summary Information DHS-7109-ENG EIDBI Individual Treatment Plan (ITP) and Progress Monitoring DHS-7122-HMN Professional Statement of Need - Hmong DHS-7122-SOM Professional Statement of Need - Somali DHS-7122-SPA Professional Statement of Need - Spanish DHS-7750-ENG Application to Provide Social Security Advocacy Services DHS-8062-ENG Setting Capacity Report DHS-8097-ENG Qualified Residential Treatment Program (QRTP) Placement Assessment and Recommendation DHS-8107-HMN Household Update Form - Hmong DHS-8107-RUS Household Update Form - Russian DHS-8107-SOM Household Update Form - Somali DHS-8107-SPA Household Update Form - Spanish DHS-8107-VIE Household Update Form - Vietnamese DHS-8132-ENG Supplement to New Family (Individual) Application DHS-8133-ENG Certification Application: Family First Prevention Services Act Specialized Settings The following form(s) were made obsolete: DHS-7108A-ENG - EIDBI Comprehensive Multi-Disciplinary Evaluation (CMDE) Medical Necessity Summary Information Signature Form (Addendum A) DHS-7109A-ENG - EIDBI Individual Treatment Plan (ITP) and Progress Monitoring Signature Form (Addendum A) DHS-7109B-ENG - Additional Developmental Goal Domains Worksheet for ITP Form (Addendum B) 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.