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DHS-2128-ENG Minnesota Health Care Programs Renewal for People Receiving Medical Assistance for Long-Term Care Services (MA-LTC)
DHS-2414-ENG Notice of Late or Incomplete Household Report Form, Health Care Renewal Form, Combined Six-Month Report or Recertification
DHS-2630-ENG Alternative Care Program Eligibility Worksheet
DHS-2630A-ENG Alternative Care Program Eligibility Worksheet Type A
DHS-2780A-ENG Behavioral Health Fund Request
DHS-3132-ENG Request For Administrative Disqualification Hearing
DHS-3418-ENG Minnesota Health Care Programs Renewal
DHS-3876-ENG MHCP Application for Certain Population
DHS-3956-ENG Elderly Waiver Conversion Rate Request
DHS-4106C-ENG Health plan enrollment form for people 65 years old or older
DHS-4138-ENG Fee-for-Service (FFS) only or FFS and Managed Care Organization In-Network Provider Agreement
DHS-4159A-ENG Adult Mental Health Rehabilitative Services Authorization Form
DHS-5032-ENG Moving Home Minnesota Intake Form
DHS-5107-ENG Administration of the Child Care Assistance Program - 2024-2025 County and Tribal Child Care Fund Plan
DHS-6020-ENG Supplemental Nutrition Assistance Program (SNAP) Employment and Training Plan
DHS-6683-ENG Essential Community Supports Program (ECS) Eligibility Worksheet
DHS-6683A-ENG Essential Community Supports Program (ECS) Eligibility Worksheet Type A
DHS-6696A-ENG Supplement to MNsure Application for Health Coverage and Help Paying Costs
DHS-6810-ENG Positive Support Transition Plan
DHS-7181-ENG Adult Rehabilitative Rehabilitative Services Provider Application
DHS-7196-ENG CCAP Provider Registration Change Form
DHS-8111-ENG DHS Material Review Checklist
DHS-8165-ENG Housing Stabilization Services additional remote support request
DHS-8262-ENG Minnesota Health Care Programs Renewal for Families, Children and Adults
DHS-8355-ENG MCO In-Network Provider Agreement
DHS-8402-ENG Uniform Service Standards Treatment Supervision Plan
DHS-8415-ENG Qualified Individual Request Form
DHS-8431-ENG Request for Information to Determine Eligibility for Certain Populations
DHS-8432-ENG Request for Information to Determine Eligibility for Families with Children and Adults
Form(s) made obsolete:
DHS-3838-ENG Opioid Treatment Program Exemption Request and Record of Justification
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