Forms published to eDocs (April 2024)

Minnesota Department of Human Services logo

Forms published to eDocs

April 2024

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DHS-1609 - Nonreceipt/Replacement Request (SPA)

DHS-2780A -  Minnesota Health Care Programs Renewal (SOM | SPA)

DHS-2984-ENG Request for Voluntary Vendor Payment

DHS-3353-ENG Appeal rights (HMN | RUS | SOM | SPA | VIE)

DHS-4016A-ENG Organization - Provider Enrollment Application

DHS-4258D-ENG Home Study Assessment

DHS-4258E-ENG Minnesota Adoption and Child Foster Care Home Study Assessment Update

DHS-5036-ENG Annuity Designation for MA-LTC Applicants

DHS-5207-ENG County agency address and phone number list

DHS-6569-ENG Private Child-Placing Agency Professional Application to Request Membership on the Permanency Email List

DHS-7948-ENG Housing Stabilization Services Eligibility Request

DHS-7955-ENG Child Care Emergency Plan

DHS-8265-ENG Opioid Prescribing Improvement Program: Quality improvement plan

DHS-8428-ENG Family First Certified Residential Placement Decision Flowchart and Checklist

DHS-8555-ENG Eligible for Manual Reimbursement for Medicare Part B Premiums for MA-EPD Enrollees

DHS-8556-ENG Ineligible for Manual Reimbursement for Medicare Part B Premiums for MA-EPD enrollees


Form(s) made obsolete:

DHS-4298 - Informed Consent Form for Psychotropic Medication(s) Use

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