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DHS-0033-ENG Appeal to State Agency
DHS-1728F-ENG Vendor's Invoice
DHS-1728G-ENG Professional Services or Grant Invoice
DHS-2630-ENG Alternative Care Program Eligibility Worksheet
DHS-2630A-ENG Alternative Care Program Eligibility Worksheet Type A
DHS-2981-ENG Medical Assistance Parental Fee Form
DHS-2981-SPA Medical Assistance Parental Fee Form - Spanish
DHS-4044-ENG Daily Car Rental Form
DHS-4929-ENG Disability Services Division: Caregiver Living Expenses Worksheet
DHS-5165-ENG Child Care Assistance Notice of Deduction for Child Support Obligation
DHS-5190-HMN Minnesota Child Care Assistance Programs Licensed Center Provider Registration and Acknowledgment - Hmong
DHS-5190-SOM Minnesota Child Care Assistance Programs Licensed Center Provider Registration and Acknowledgment - Somali
DHS-5190-SPA Minnesota Child Care Assistance Programs Licensed Center Provider Registration and Acknowledgment - Spanish
DHS-5191-HMN Minnesota Child Care Assistance Programs License Exempt Provider Registration and Acknowledgment - Hmong
DHS-5191-SOM Minnesota Child Care Assistance Programs License Exempt Provider Registration and Acknowledgment - Somali
DHS-5191-SPA Minnesota Child Care Assistance Programs License Exempt Provider Registration and Acknowledgment - Spanish
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-6751U-ENG EIDBI service decision tool
DHS-7195-HMN Licensed Family Child Care Provider Registration and Acknowledgment - Hmong
DHS-7195-SOM Licensed Family Child Care Provider Registration and Acknowledgment - Somali
DHS-7195-SPA Licensed Family Child Care Provider Registration and Acknowledgment - Spanish
DHS-5820C-ENG Lead agency provider tool for DWRS exceptions (residential)
DHS-5820D-ENG Lead agency provider tool for DWRS exceptions (day or unit)
DHS-7325-ENG 1115 Substance Use Disorder System Reform Enrollment Checklist
DHS-8242-ENG Minnesota Child Care Assistance Program - Calculation of self-employment income
DHS-8243-ENG AC/EW PCA Enhanced Rate Budget Exception Request
DHS-8273-ENG Attestation for Targeted Case Management Vendor Contracts
DHS-8275-ENG Culturally Specific or Culturally Responsive Program Rate Enhancement Attestation for Licensed Substance Use Disorder Programs
DHS-8279-ENG Non-disqualifying Background Study Information Assessment
Form(s) made obsolete:
DHS-3539A-ENG - Ryan White Six-Month Recertification
DHS-6516-ENG - MHCP: Early Intensive Developmental and Behavioral Intervention (EIDBI) Technical Change Request
DHS-6516A-ENG - MHCP: Instructions to complete the EIDBI Technical Change Request Form (DHS-6516)
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