Forms published to eDocs (June 2021)

Minnesota Department of Human Services logo

Forms published to eDocs

June 2021

eDocs

 

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.

 

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