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DHS-2114-ENG Request for Medical Opinion
DHS-2338-HMN Cooperation with Child Support - Hmong
DHS-2338-RUS Cooperation with Child Support - Russian
DHS-2338-SOM Cooperation with Child Support - Somali
DHS-2338-SPA Cooperation with Child Support - Spanish
DHS-2338-VIE Cooperation with Child Support - Vietnamese
DHS-2818-ENG Authorization for Out-of-State Travel
DHS-2984-ENG Request for Voluntary Vendor Payment
DHS-3426-ENG OBRA Level I Criteria – Screening for Developmental Disabilities or Mental Illness
DHS-3550-ENG Minnesota Child Care Assistance Program Application
DHS-3883-ENG SMRT Education and Work History
DHS-4016-ENG MHCP Individual Provider Enrollment Application
DHS-4677A-ENG ICF/DD Variable Rate Recommendation
DHS-4718-ENG Electronic Remittance Advice (RA) Request
DHS-5190-ENG Minnesota Child Care Assistance Programs Licensed Center Provider Registration and Acknowledgment
DHS-5191-ENG Minnesota Child Care Assistance Programs License Exempt Provider Registration and Acknowledgment
DHS-5274-ENG Minnesota Child Care Assistance Program Redetermination Form
DHS-5893B-ENG Medical Assistance Clearance Certificate
DHS-6037-ENG HCBS Waiver, AC, and ECS Case Management Transfer and Communication Form
DHS-6381-ENG Residential or Inpatient Behavioral Health Fund (BHF) Service Request
DHS-6382-ENG Outpatient Behavioral Health Fund (BHF) Service Request
DHS-6638-ENG Home and Community-Based Services (HCBS) Programs Service Request
DHS-6818-ENG COVID19 temporary staffing application
DHS-7120B-ENG Early Intensive Developmental and Behavioral Intervention (EIDBI) Provider Agency Assurance Statement
DHS-7195-ENG Licensed Family Child Care Provider Registration and Acknowledgment
DHS-7307-HMN Housing Focused Person-Centered Plan - Hmong
DHS-7307-SOM Housing Focused Person-Centered Plan - Somali
DHS-7307-SPA Housing Focused Person-Centered Plan - Spanish
DHS-7750-SOM Application to Provide Social Security Advocacy Services - Somali
DHS-7750-SPA Application to Provide Social Security Advocacy Services - Spanish
DHS-7750-HMN Application to Provide Social Security Advocacy Services - Hmong
DHS-7955-ENG Child Care Emergency Plan
DHS-8107-ENG Household Update Form
DHS-8143-ENG Opioid Prescribing Improvement Program (OPIP) Provider Confirmation
DHS-8164-ENG Private Room Request
DHS-8204-ENG Waiver case manager support for additional Housing Stabilization Services hours
DHS-8251-ENG Community First Services and Supports (CFSS) Consultation Service Provider Agreement Addendum
DHS-8256-ENG Request to carry forward FY 2022 HCBS operating funds to FY 2023
DHS-8259-ENG Community First Service and Supports (CFSS) Consultation Service Provider Surety Bond
DHS-8260-ENG CFSS Consultation Service Provider Enrollment Application
The following form(s) were made obsolete:
DHS-3747-ENG - Individualized Home Supports Provider Assurance Statement
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