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DHS-2992-ENG Authorization to Share Information
DHS-3048-ENG Tribal Nation Membership
DHS-3336-ENG Self Employment Gross Income Report For
DHS-3539-ENG Ryan White Annual Certification
DHS-3539B-ENG Ryan White New Applicant Form
DHS-4005-HMN Telephone Equipment Distribution Program application - Hmong
DHS-4005-RUS Telephone Equipment Distribution Program application - Russian
DHS-4005-SOM Telephone Equipment Distribution Program application - Somali
DHS-4005-SPA Telephone Equipment Distribution Program application - Spanish
DHS-4005-VIE Telephone Equipment Distribution Program application - Vietnamese
DHS-4646-ENG MHCP Child and Teen Checkups (C&TC) Provider Agreement Addendum
DHS-5223-HMN Combined Application Form - Hmong
DHS-5223-RUS Combined Application Form - Russian
DHS-5223-SOM Combined Application Form - Somali
DHS-5223-SPA Combined Application Form - Spanish
DHS-5223-VIE Combined Application Form - Vietnamese
DHS-5223S-ENG Combined Application Form Household Member Supplement
DHS-5223S-HMN Combined Application Form Household Member Supplement - Hmong
DHS-5223S-RUS Combined Application Form Household Member Supplement - Russian
DHS-5223S-SOM Combined Application Form Household Member Supplement - Somali
DHS-5223S-SPA Combined Application Form Household Member Supplement - Spanish
DHS-5223S-VIE Combined Application Form Household Member Supplement - Vietnamese
DHS-5360-ENG Children's Mental Health Intensive Treatment in Foster Care: Certification Application
DHS-5360C-ENG Children's Mental Health Intensive Treatment in Foster Care: Notification of Change
DHS-5504B-ENG Exception Request for Environmental Accessibility Adaptations that Exceed $40,000 (CAC, CADI, BI and DD Waivers)
DHS-5887-ENG Additional Square Footage Checklist
DHS-6381-ENG Residential or Inpatient Behavioral Health Fund (BHF) Service Request
DHS-6382-ENG Outpatient Behavioral Health Fund (BHF) Service Request
DHS-6451-ENG Special Needs BasicCare (SNBC) Choice Form
DHS-6633A-ENG CDCS Community Support Plan Addendum
DHS-6696-ENG MNsure Application for Health Coverage and Help Paying Cost
DHS-6696-HMN MNsure Application for Health Coverage and Help Paying Costs - Hmong
DHS-6696-RUS MNsure Application for Health Coverage and Help Paying Costs - Russian
DHS-6696-SOM MNsure Application for Health Coverage and Help Paying Costs - Somali
DHS-6696-SPA MNsure Application for Health Coverage and Help Paying Costs - Spanish
DHS-6696-VIE MNsure Application for Health Coverage and Help Paying Costs - Vietnamese
DHS-6696B-ENG Supplement to the Minnesota Health Care Programs Application for Certain Populations
DHS-6696B-HMN Supplement to the Minnesota Health Care Programs Application for Certain Populations - Hmong
DHS-6696B-RUS Supplement to the Minnesota Health Care Programs Application for Certain Populations - Russian
DHS-6696B-SOM Supplement to the Minnesota Health Care Programs Application for Certain Populations - Somali
DHS-6696B-SPA Supplement to the Minnesota Health Care Programs Application for Certain Populations - Spanish
DHS-6696B-VIE Supplement to the Minnesota Health Care Programs Application for Certain Populations - Vietnamese
DHS-6696C-ENG MNsure Application for Health Coverage and Help Paying Costs Signature Pages
DHS-6696D-ENG MNsure Appendix A - Health Coverage from Jobs
DHS-6696D-HMN MNsure Appendix A - Health Coverage from Jobs - Hmong
DHS-6696D-RUS MNsure Appendix A - Health Coverage from Jobs - Russian
DHS-6696D-SOM MNsure Appendix A - Health Coverage from Jobs - Somali
DHS-6696D-SPA MNsure Appendix A - Health Coverage from Jobs - Spanish
DHS-6696D-VIE MNsure Appendix A - Health Coverage from Jobs - Vietnamese
DHS-6810D-ENG Request for the Authorization of the Emergency Use of Procedures
DHS-7122-AMH Professional Statement of Need for Housing Stabilization Services and Minnesota Housing Support - Amharic
DHS-7122-HMN Professional Statement of Need for Housing Stabilization Services and Minnesota Housing Support - Hmong
DHS-7122-ORM Professional Statement of Need for Housing Stabilization Services and Minnesota Housing Support - Oromo
DHS-7122-SOM Professional Statement of Need for Housing Stabilization Services and Minnesota Housing Support - Somali
DHS-7122-SPA Professional Statement of Need for Housing Stabilization Services and Minnesota Housing Support - Spanish
DHS-7679-ENG Appointment Letter
DHS-7683-ENG Accreditation Fee Reimbursement Request
DHS-7696-ENG Psychiatric Residential Treatment Facility (PRTF) Eligibility for Admission
DHS-8291-ENG Minnesota Intrastate Referral (MIR)
Form(s) made obsolete:
None
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