Forms published to eDocs (November 2024)

Minnesota Department of Human Services logo

Forms published to eDocs

November 2024

eDocs logo

DHS-2868-ENG MHCP Hospice Transaction Form

DHS-3531-SPA Application for Medical Assistance for Long-Term-Care Services (MA-LTC)

DHS-3943B - The Child Care Assistance Program (CCAP): What to know about fraud - information for families (HMN | RUS | SOM | SPA | VIE)

DHS-3956-ENG Elderly Waiver Conversion Rate Request

DHS-4005-ENG Minnesota Access to Communication Technology Application

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

DHS-4117 - Automatic withdrawal for your support payments (HMN | SOM | SPA)

DHS-4163-ENG Client responsibilities and rights

DHS-4163L-ENG Client responsibilities and rights (Large print)

DHS-4740-ENG Minnesota Family Planning Program (MFPP) Application and Renewal Form (HMN | RUS | SOM | SPA | VIE)

DHS-4839K-ENG Notice of Privacy Practices and Rights and Responsibilities for DHS-6696/6696B (HMN | RUS | SOM | SPA | VIE)

DHS-5190 - Minnesota Child Care Assistance Programs Licensed Center Provider Registration and Acknowledgment (HMN | SOM | SPA)

DHS-5191 - Minnesota Child Care Assistance Programs License Exempt Provider Registration and Acknowledgment (HMN | SOM | SPA)

DHS-5924-ENG Housing Support Supplemental Services Provider Enrollment Application

DHS-6451-ENG Special Needs BasicCare (SNBC) Choice Form

DHS-6532-ENG CDCS Community Support Plan

DHS-6696-ENG MNsure Application for Health Coverage and Help Paying Costs (HMN | RUS | SOM | SPA | VIE)

DHS-6696A-ENG Supplement to Application for Health Coverage and Help Paying Costs (HMN | RUS | SOM | SPA | VIE)

DHS-6696B-ENG Supplement to the Minnesota Health Care Programs Application for Certain Populations (HMN | RUS | SOM | SPA | VIE)

DHS-6790C-ENG RMS Worksheet — Community Residential Services or Family Residential Services

DHS-6893N-ENG Consultation services provider CFSS service delivery plan cover sheet

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

DHS-7117-ENG MHCP Yearly Income Statement

DHS-7195 - Licensed Family Child Care Provider Registration and Acknowledgment (HMN | SOM | SPA)

DHS-7641R-ENG Youth Exploitation or Trafficking Safety Plan (FRE | HMN | KAR | ORM | RUS | SOM | SPA | CHS)

DHS-8111-ENG MHCP Material Review Checklist

DHS-8160-ENG Community First Services and Supports (CFSS) Agency Enrollment Application

DHS-8334 - Cancel Appeal to State Agency (HMN | RUS | SOM | SPA | VIE)

DHS-8456-ENG SNAP Work Rules Screening Question

 

Form(s) made obsolete

None

 


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