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DHS-2780A-ENG Behavioral Health Fund Request
DHS-2828B-ENG Long-Term Services and Supports Notice of Action – Explanation of Changes to Your Support Plan
DHS-4005-ENG Telephone Equipment Distribution Program Application (HMN | RUS | SOM | SPA | VIE)
DHS-4005C-ENG Consent to Release Information (HMN | RUS | SOM | SPA | VIE)
DHS-4005L-ENG Telephone Equipment Distribution Program Application (Large Print)
DHS-4026-ENG DWP/MFIP Screening Questions
DHS-4074-ENG MA Home Care Technical Change Request
DHS-4074A-ENG Personal Care Assistance (PCA) Technical Change Request
DHS-4292-ENG PCA Request Form
DHS-4296-ENG Opioid Treatment Program Central Registry, General Consent/Authorization for Release of Information
DHS-4794-ENG CCAP Change Report Form
DHS-5367 – Minnesota Child Care Assistance Programs - Parent Acknowledgment When Choosing a Legal Nonlicensed Provider (HMN | SOM | SPA)
DHS-5538-ENG Home Trial Log for Stander
DHS-7097-ENG Employer Insurance Verification Form
DHS-7323-ENG 1115 Substance Use Disorder (SUD) System Reform Demonstration Project Provider Assurance Statement
DHS-7348-ENG Annual Goal and Development Plan
DHS-8084-ENG School-Based Community Services (Intent to Bill)
DHS-8111-ENG DHS Material Review Checklist
DHS-8159-ENG Supplemental Nutrition Assistance Program (SNAP) Work Rules Notice
DHS-8262-ENG Minnesota Health Care Programs Renewal for Families, Children and Adults
DHS-8376-ENG SNAP Homeless Shelter Deduction Worksheet
DHS-8468A-ENG Child Care Assistance Program – Application Checklist
DHS-8468B-ENG Child Care Assistance Program – Redetermination checklist
Form(s) made obsolete:
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