Forms published to eDocs (October 2023)

Minnesota Department of Human Services logo

Forms published to eDocs

September 2023

eDocs logo

DHS-4106C-ENG Health plan enrollment form for people 65 years old or older

DHS-4258B-ENG Minnesota Adoption and Foster Care Individual Fact Sheet

DHS-4296-ENG Opioid Treatment Program Central Registry, General Consent/Authorization for Release of Information

DHS-4719-ENG Guidelines for Developing Policies and Procedures - Licensed Child Care Centers

DHS-4719A-ENG Guidelines for Developing Policies and Procedures for Certified Centers

DHS-5538-SPA Home Trial Log for Stander

DHS-5576 – Combined Six-Month Report – Supplement for Cash Programs (HMN | RUS | SOM | SPA | VIE)

DHS-5849-ENG Program HH: Nutritional Supplemental Authorization Request

DHS-6189Y-ENG Waiver Transportation Provider Assurance Statement

DHS-7109-ENG EIDBI Individual Treatment Plan (ITP) and Progress Monitoring

DHS-7118-ENG Universal Licensing Application

DHS-7181-ENG Adult Rehabilitative Rehabilitative Services Provider Application

DHS-7181B-ENG Adult Rehabilitative Mental Health Services (ARMHS) Recertification Application

DHS-7181C-ENG Mental Health Adult Rehabilitative Mental Health Services (ARMHS) Branch Office Location Application

DHS-7645A– EIDBI Benefit: Your rights and responsibilities (CMN | HMN | KAR | ORM | RUS | SOM | SPA | VIE)

DHS-7995-ENG Individual Child Care Program Pla

DHS-8262-SPA Minnesota Health Care Programs Renewal for Families, Children and Adults

DHS-8445-ENG MHCP Asset Information

DHS-8450-ENG Guardian-Conservator Maltreatment and Licensing Agency Checks

DHS-8462-ENG State Medical Review Team (SMRT) Document Portal

DHS-8493-ENG SNAP Employment and Training (E&T) Information and Screening and Referral Questions


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