Forms published to eDocs (July 2025)

Minnesota Department of Human Services logo

Forms published to eDocs

July 2025

eDocs logo

DHS-1956-ENG Consent to adoption for youth over 14 years of age

DHS-2116-ENG Notice to Apply for Other Maintenance Benefits

DHS-3376-ENG Notification to School to Interview Child

DHS-3403-ENG Minnesota Health Care Programs Fee-for-Service Coverage

DHS-3418-ENG Minnesota Health Care Programs Renewal (HMN | RUS | SOM | SPA | VIE)

DHS-3437-ENG Minnesota Health Care Programs - Giving Permission for Someone to Act on My Behalf

DHS-3741A-ENG Minnesota Family Planning Program – Your Appeal Rights

DHS-3879-ENG Moving Home Minnesota (MHM) - Transition Planning, Transition Coordination and Demonstration Case Management - Provider Assurance Statement

DHS-4005C - Consent to Release Information (HMN | RUS | SOM | SPA VIE)

DHS-5139-ENG Case Corrective Action Form - Minnesota Medical Eligibility Audit

DHS-5181-ENG LTC: Communication of Long-term Supports and Services Eligibility Form

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

DHS-5523-ENG Child Care Assistance Billing Form

DHS-6021-ENG Request to Close or Develop New Corporate Foster Care and Community Residential Settings

DHS-6893W-ENG Lead agency addendum to CFSS Individual Service Delivery Plan (DHS-6893P) 

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

DHS-7120B-ENG Early Intensive Developmental and Behavioral Intervention (EIDBI) Provider Agency Assurance Statement

DHS-7120C-ENG Early Intensive Developmental and Behavioral Intervention (EIDBI) Qualified Supervising Professionals (QSP) Assurance Statement

DHS-7120D-ENG Early Intensive Developmental and Behavioral Intervention (EIDBI) Level I Provider Assurance Statement 

DHS-7325-ENG ASAM Certification Checklist

DHS-7634A-ENG Maltreatment of Minors Mandated Reporting policy

DHS-7634D-ENG Maltreatment of Minors Mandated Reporting policy - Certified child care centers

DHS-7634E-ENG Maltreatment of Minors Mandated Reporting policy - DHS licensed programs

DHS-7634F-ENG Maltreatment of Minors Mandated Reporting policy - Certified mental health centers and clinics

DHS-8111-ENG MHCP Material Review Checklist

DHS-8629-ENG Great Start Compensation Support Payment Program: Use of Funds Report – Request a Report

DHS-8641-ENG General Assistance - Applying Changes in Assistance Standards 

DHS-8675-ENG External Partner Conflict of Interest Disclosure Form

DHS-8675A-ENG COI Disclosure Form for Competitive Grant Reviews

DHS-8709-ENG Mental Status Examination

 

Form(s) made obsolete

DHS-4293-ENG - Maltreatment of Minors and Licensing Violations Report Form

 


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