Forms published to eDocs (August 2023)

Minnesota Department of Human Services logo

Forms published to eDocs

August 2023

eDocs logo

DHS-1609 - Nonreceipt/Replacement Affidavit (ENGSPA)

DHS-2116-ENG Notice to Apply for Other Maintenance Benefits

DHS-2414 - Notice of Late or Incomplete Household Report Form, Health Care Renewal Form, Combined Six-Month Report or Recertification (ENGHMNRUSSOMSPAVIE)

DHS-2727-ENG Long-Term Services and Supports Assessment and Program Information and Signature Sheet

DHS-2776-ENG Computation of MFIP Overpayment Worksheet

DHS-2776A-ENG Computation of Supplemental Nutrition Assistance Program Overpayment Worksheet

DHS-5181-ENG LTC: Communication of long-term supports and services eligibility form

DHS-5576A-ENG Combined Six-Month Report -- Supplement for Cash Programs

DHS-6749A-ENG GA or MSA Notice of Drug Felon Match

DHS-6749B-ENG MFIP Notice of Drug Felon Match

DHS-7018-ENG Disclosure of Funding Form – Grant RFP

DHS-7325-ENG 1115 Substance Use Disorder System Reform Enrollment Checklist

DHS-8062-ENG Setting Capacity Report

DHS-8157-ENG Elderly Waiver Customized Living Services Disproportionate Share Facility Application

DHS-8264E-ENG OPIP Measure 5 & 6 Self Assessment 


Form(s) made obsolete:

DHS-5204-ENG - Alcohol and Drug Abuse Division Rule 25 Assessment

DHS-5638-ENG - Mental Health Targeted Case Management (MH-TCM) Contract Cover Sheet

DHS-6330-ENG - Qualified Mental Health Professional Clinical Supervision Assurance Statement

DHS-8264C-ENG - Opioid Prescribing Improvement Program: Measure 5 self-assessment

DHS-8264D-ENG - Opioid Prescribing Improvement Program: Measure 6 self-assessment

Please note that the following forms may have new web addresses. Web pages or other documents that link to these forms may need to be updated.


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