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DHS-2114-ENG Request for Medical Opinion
DHS-2120-ENG Household Report Form (HMN | RUS | SOM | SPA | VIE)
DHS-3159M-ENG Household Report Form
DHS-3418-ENG Minnesota Health Care Programs Renewal
DHS-3443-ENG Individual Discharge Information Shee
DHS-3727-ENG Combined Annual Renewal For Certain Populations
DHS-3767-ENG Request for Group Health Plan Information (SOM | SPA)
DHS-3767A-ENG Request for Employee's Group Health Plan Information
DHS-3767E-ENG Your Health Insurance Is Cost Effective (SOM | SPA)
DHS-4740 - Minnesota Family Planning Program (MFPP) Application and Renewal Form (HMN | RUS | SOM | SPA | VIE)
DHS-4797B-ENG Behavioral Health Home (BHH) Services Rights, Responsibilities and Consent
DHS-4839K - Notice of Privacy Practices and Rights and Responsibilities for DHS-6696/6696B (HMN | RUS | SOM | SPA | VIE)
DHS-5038-ENG Minnesota Health Care Programs Request to Reopen Medical Assistance (MA)
DHS-5192 - Minnesota Child Care Assistance Programs Legal Nonlicensed Provider Registration and Acknowledgment (HMN | SOM | SPA)
DHS-5223F-ENG Supplemental Nutrition Assistance Program (SNAP) Application for Seniors (Individuals and couples age 60 and older)
DHS-5239F - Minnesota Family Planning Program Application and Renewal Form – Signature Page (HMN | RUS | SOM | SPA | VIE)
DHS-5367-ENG Minnesota Child Care Assistance Programs - Parent Acknowledgment When Choosing a Legal Nonlicensed Provider
DHS-6633B-ENG CDCS Enhanced Budget Request and Community Support Plan Addendum
DHS-6696G-ENG Medical Assistance (MA) Inpatient Hospital Coverage for Incarcerated People
DHS-6791E-ENG MnCHOICES Communication Form
DHS-7108-ENG CMDE Medical Necessity Summary Information
DHS-7109-ENG EIDBI Individual Treatment Plan (ITP) and Progress Monitoring
DHS-7109F-ENG EIDBI Safety Plan Template
DHS-7109S-ENG Individual Treatment Plan (ITP) and Progress Monitoring Signature Page
DHS-7196-ENG CCAP Provider Registration Change Form
DHS-7786-ENG Request for Fire Inspection or Reinspection
DHS-8062-ENG Setting Capacity Report
DHS-8243-ENG AC/EW PCA Enhanced Rate Budget Exception Request
DHS-8262-ENG Minnesota Health Care Programs Renewal for Families, Children and Adults
DHS-8429-ENG Qualifying as a Certified Child Care Center
DHS-8433-ENG Certificate of Service
Form(s) made obsolete:
DHS-3902-ENG Request for Information after Renewal
DHS-5163-ENG Child Care Assistance Notice of Deduction for IRS Levy
DHS-5164-ENG Child Care Assistance Notice of Deduction for Continuous Levy
DHS-5166-ENG Child Care Assistance Notice of Deduction for Backup Withholding
DHS-5167-ENG First B Notice
DHS-5168-ENG Second B Notice
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