 DHS-2116-ENG Notice to Apply for Other Maintenance Benefits
DHS-3067-ENG DD Screening Document
DHS-3159B-ENG Minnesota Voluntary Recognition of Parentage Revocation Form (HMN | SOM | SPA)
DHS-3550-ENG Minnesota Child Care Assistance Program Application
DHS-3741-ENG Your Appeal Rights (HMN | RUS | SOM | SPA | VIE)
DHS-3956-ENG Elderly Waiver Conversation Rate Request
DHS-4005C-ENG Consent to Release Information
DHS-4194-ENG CCAP Special Needs Rate Variance Request – Parent and Provider Request
DHS-4259-ENG MDHS Verification of Identity and Request for Information
DHS-4695-ENG MHCP Authorization Form
DHS-4794-ENG Child Care Assistance Program (CCAP) – Change Report Form (HMN | RUS | SOM | SPA | VIE)
DHS-4813A-ENG C&TC Screening Components Standards and Guidelines
DHS-4813B-ENG Child and Teen Checkups 2-Month Well Visit
DHS-4813C-ENG Child and Teen Checkups 4-Month Well Visit
DHS-4813D-ENG Child and Teen Checkups 6-Month Well Visit
DHS-4813E-ENG Child and Teen Checkups 9-Month Well Visit
DHS-4813F-ENG Child and Teen Checkups 12-Month Well Visit
DHS-4813G-ENG Child and Teen Checkups 15-Month Well Visit
DHS-4813H-ENG Child and Teen Checkups 18-Month Well Visit
DHS-4813I-ENG Child and Teen Checkups 24-Month Well Visit
DHS-4813J-ENG Child and Teen Checkups 30-Month Well Visit
DHS-4813K-ENG Child and Teen Checkups 3-year well child visit
DHS-4813L-ENG Child and Teen Checkups 4-Year Well Visit
DHS-4813M-ENG Child and Teen Checkups 5-Year Well Visit
DHS-5107-ENG Administration of the Child Care Assistance Program - 2024-2025 County and Tribal Child Care Fund Plan
DHS-5192 - Minnesota Child Care Assistance Programs Legal Nonlicensed Provider Registration and Acknowledgment (HMN | SOM | SPA)
DHS-5192D-ENG CCAP Legal Nonlicensed Provider Local Emergency Contacts
DHS-5192E-ENG CCAP Legal Nonlicensed Provider Child Emergency Contact Information
DHS-5192F-ENG Minnesota Child Care Assistance Program Group Size and Age Limits for Legal Nonlicensed (LNL) Child Care Providers
DHS-5223S-ENG Combined Application Form Household Member Supplement
DHS-5367-ENG Minnesota Child Care Assistance Programs - Parent Acknowledgment When Choosing a Legal Nonlicensed Provider
DHS-5678-ENG Request for Individual Personal Care Assistant (PCA) Enrollment Resubmission
DHS-5788A-ENG CDCS Community Support Plan
DHS-6189CA-ENG Customized Living Enrollment Date Transfer Assurance Statement
DHS-6562-ENG Advisory Committee Application Form
DHS-6638-ENG Home and Community-Based Services (HCBS) Programs Service Request
DHS-6715-ENG Protected Transport - Level-of-Service (LOS) Assessment
DHS-6759P-ENG Moving Home Minnesota Community Services and Supports Plan
DHS-7309-ENG Patient Referral Arrangement Agreement
DHS-7337-ENG Request for public data
DHS-7338-ENG Request for private data about yourself
DHS-7634C-ENG Maltreatment of minors mandated reporting policy, Family Child Care
DHS-7683-ENG Accreditation Fee Reimbursement Request
DHS-7695-ENG Psychiatric Residential Treatment Facility (PRTF) Extended Leave Request
DHS-7886-ENG Crisis Respite Specialized Staff Provider Assurance Statement
DHS-7953B-ENG Orientation Training Record - Certified Child Care Centers
DHS-8056-ENG Deaf, DeafBlind and Hard of Hearing State Services Division Permission to Share Information
DHS-8667-ENG Child Care Assistance Program Parent Mental Health Condition Form
DHS-8681-ENG Notice of Child Fatality/Near Fatality
DHS-8681A-ENG Review of Child Fatality/Near Fatality (Template)
DHS-8704-ENG Vendor's Invoice Board and Committee Members
DHS-8705-ENG Vendor's Invoice P/T Service or Grant Contract
DHS-8710-ENG DCYF Daily Car Rental Form
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