DHS-2630-ENG Alternative Care Program Eligibility Worksheet for Unmarried Individuals or Married Couples When Both May Choose the Alternative Care Program or a Married Person Whose Spouse Is an EW Recipient or Is Living in a Nursing Facility

DHS-2630A-ENG Alternative Care Program Eligibility Worksheet for a Married Person who has a Community Spouse

DHS-2780A-ENG Client Placement Authorization CPA-CCDTF

DHS-2818-ENG Authorization for Out-of-State Travel

DHS-3535-ENG MHCP Individual Provider Profile Change Form

DHS-3539-ENG Ryan White Annual Certification

DHS-3539B-ENG Ryan White New Applicant/Information Change

DHS-3549-ENG General Consent/Authorization for Release of Information

DHS-3550-ENG Minnesota Child Care Assistance Program Application

DHS-4016-ENG MHCP Individual Provider Enrollment Application

DHS-5107-ENG Administration of the Child Care Assistance Program - 2022-2023 County and Tribal Child Care Fund Plan

DHS-5705-ENG Minnesota foster care placement verification for post-secondary schools form

DHS-5856-ENG MHCP Personal Care Assistance (PCA) Program Responsible Party Agreement and Plan

DHS-5862-ENG Separation Report

DHS-6189X-ENG Customized Living Provider Assurance Statement

DHS-6322-ENG Initial Dialectical Behavior Therapy (DBT) Intensive Outpatient Program (IOP) Authorization

DHS-6638-ENG HCBS Programs Service Request Form

DHS-6683-ENG Essential Community Supports Program (ECS) Financial Eligibility Worksheet

DHS-6683A-ENG Essential Community Supports Program (ECS) Eligibility Worksheet for a Married Individual when only one spouse is requesting services

DHS-6790M-ENG RMS Worksheet – Day and Employment Services

DHS-6826-ENG Essential Community Supports Program(ECS) Financial Disclosure Form

DHS-7016-ENG State of Minnesota Workforce Certificate Information

DHS-7109-ENG EIDBI Individual Treatment Plan (ITP) and Progress Monitoring

DHS-7122-AMH Professional Statement of Need - Amharic

DHS-7359-ENG Renewal Yearly Income Statement

DHS-7995-ENG Individual Child Care Program Plan (ICCPP)

DHS-8084-ENG School-Based Community Services (Intent to Bill)

DHS-8116-ENG Customized Living Services – Exempt from Assisted Living Facility Licensure – Provider Assurance Statement

DHS-8142-ENG Opioid Prescribing Quality Improvement Report Form

DHS-8143-ENG Secure document Opioid Prescribing Improvement Program (OPIP) Provider Attestation

DHS-8144-ENGPooled Trust Transfer Evaluation Worksheet