 DHS-1609-SPA Nonreceipt/Replacement Request
DHS-1795-ENG SSI Interim Assistance Authorization
DHS-3418-ENG Minnesota Health Care Programs Renewal
DHS-3550-ENG Minnesota Child Care Assistance Program Application
DHS-4016-ENG MHCP Individual Provider Enrollment Application
DHS-4163 - Client responsibilities and rights (HMN | RUS | SOM | SPA | VIE)
DHS-4461-ENG Nursing Facility (NF) Communication Form
DHS-4469-ENG Individual Personal Care Assistant (PCA) Enrollment Application
DHS-4797-ENG Notification of Eligibility for Behavioral Health Home (BHH) Services
DHS-4915-ENG Medical Assistance (MA) Payment of Long-Term Care Services
DHS-5223D - Combined Application - Child Care Addendum (HMN | RUS | SOM | SPA | VIE)
DHS-5274 - Combined Application - Child Care Addendum (HMN | RUS | SOM | SPA | VIE)
DHS-5841-ENG Managed Care Organization, County Agency and Tribal Nation Communication Form - Recommendation for State Plan Home Care Services
DHS-6125B-ENG State Medical Review Team Adult Continuing Disability Review Worksheet
DHS-6126-ENG State Medical Review Team Children's Disability Worksheet
DHS-6126B-ENG State Medical Review Team Children's Continuing Disability Review Worksheet
DHS-6189H-ENG Family Caregiver Services Provider Assurance Statement
DHS-6189CC-ENG Personal Emergency Response System Provider Assurance Statement
DHS-6383-ENG Lead Agency Assurance Statement: HCBS Provider Review and Approval
DHS-6715-ENG Protected Transport - Level-of-Service (LOS) Assessment
DHS-6759I-ENG Moving Home Minnesota (MHM) Informed Consent Form
DHS-6759N-ENG Moving Home Minnesota (MHM) Transition Coordination Services Referral Form
DHS-6806-ENG Telehealth Provider Assurance Statement
DHS-6979-ENG MnCHOICES Help Desk Contact Form
DHS-7020-ENG Responder Information/Declarations Form – Grant RFP
DHS-7122-ENG Professional Statement of Need for Housing Stabilization Services and Minnesota Housing Support
DHS-7359-ENG Renewal Yearly Income Statement
DHS-7823-ENG Authorization to Obtain Financial Information from the Account Validation Service (AVS)
DHS-7896-ENG Documentation to Establish Financial Stability – Grants
DHS-8018-ENG Housing Stabilization Services – Provider Enrollment Application
DHS-8121-ENG Day Training and Habilitation (ICF/DD) Provider Enrollment Application
DHS-8225-ENG Rate Exception Request: Fee-for-Service Subcontracted Targeted Case Management
DHS-8373-ENG Child Care Center Medication Authorization
DHS-8407-ENG Complaint and Grievance Procedures for Foster Care
DHS-8456 - SNAP Work Rules Screening Questions (HMN | RUS | SOM | SPA | VIE)
DHS-8479A-ENG Psychotropic medication monitoring form: Background information and support team observations
DHS-8479B-ENG Psychotropic medication monitoring form: Effects on quality of life and person-centered summary
DHS-8479C-ENG Psychotropic medication monitoring form: 4+1 questions tool
DHS-8479D-ENG Psychotropic medication monitoring form: What is working and not working tool
DHS-8479E-ENG Psychotropic medication monitoring form: Important to/for tool
DHS-8479F-ENG Psychotropic medication monitoring form: Relationship chart tool
DHS-8483-ENG General Request for Reconsideration of a Disqualification
DHS-8511-ENG Information about Joint Bank Accounts
DHS-8513-ENG Recuperative Care Extended Stay Request
DHS-8533-ENG FFPSA Allocation Agency Plan
Form(s) made obsolete:
DHS-7694-ENG - Psychiatric Residential Treatment Facility (PRTF) Notice of Denial
DHS-7697-ENG - Psychiatric Residential Treatment Facility (PRTF) Pending Notice
DHS-7699-ENG - Psychiatric Residential Treatment Facility (PRTF) Notice of Approval
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