 DHS-2402B-ENG (PDF) Change Report Form for the Supplemental Nutrition Assistance Program
DHS-2828C-ENG (PDF) Notice of Temporary Service Suspension
DHS-2828D-ENG (PDF) Notice of Service Termination
DHS-3165A-ENG Supplemental Nutrition Assistance Program Employment and Training (SNAP E&T) Status Update Form
DHS-3799B-ENG Child foster care notice to relatives: Permanency
DHS-3943B-ENG (PDF) The Child Care Assistance Program (CCAP): What to know about fraud - information for families [ HMN (PDF) | RUS (PDF) | SOM (PDF) | SPA (PDF) | VIE (PDF) ]
DHS-4005-ENG (PDF) Minnesota Access to Communication Technology Application
[ HMN (PDF) | RUS (PDF) | SOM (PDF) | SPA (PDF) | VIE (PDF) ]
DHS-4005L-ENG (PDF) Minnesota Access to Communication Technology Application Large Print
DHS-4163-ENG SNAP Client Responsibilities and Rights [ HMN (PDF) | RUS (PDF) | SOM (PDF) | SPA (PDF) | VIE (PDF) ]
DHS-4292-ENG PCA Request Form
DHS-4461A-ENG Nursing Facility (NF) Liability Summary
DHS-4719-ENG Guidelines for Developing Policies and Procedures - Licensed Child Care Centers
DHS-4794-ENG (PDF) Child Care Assistance Program (CCAP) – Change Report Form
DHS-4813N-ENG (PDF) Child and Teen Checkups 6-Year Well Visit
DHS-4813O-ENG (PDF) Child and Teen Checkups 7-Year Well Visit
DHS-4813P-ENG (PDF) Child and Teen Checkups 8-Year Well Visit
DHS-4813Q-ENG (PDF) Child and Teen Checkups 9-Year Well Visit
DHS-4813R-ENG (PDF) Child and Teen Checkups 10-Year Well Visit
DHS-4813S-ENG (PDF) Child and Teen Checkups 11-Year Well Visit
DHS-4813T-ENG (PDF) Child and Teen Checkups 12-Year Well Visit
DHS-4813U-ENG (PDF) Child and Teen Checkups 13 and 14-Year Well Visit
DHS-4813V-ENG (PDF) Child and Teen Checkups 15-Year Well Visit
DHS-4813W-ENG (PDF) Child and Teen Checkups 16-Year Well Visit
DHS-4813X-ENG (PDF) Child and Teen Checkups 17-Year Well Visit
DHS-4813Y-ENG (PDF) Child and Teen Checkups 18-Year Well Visit
DHS-4813Z-ENG (PDF) Child and Teen Checkups 19 and 20-Year Well Visit
DHS-5207-ENG (PDF) County and Tribal Nation agency address and phone number list
DHS-5223D-ENG Combined Application - Child Care Addendum
DHS-5223F-ENG Supplemental Nutrition Assistance Program (SNAP) Application for Seniors (Individuals and couples age 60 and older)
DHS-5588-ENG (PDF) Child Care Assistance Notice of Decision - Denial
DHS-5588A-ENG (PDF) Child Care Assistance Notice of Decision - Termination
DHS-6189C-ENG (PDF) Adult Companion Services or Individualized Home Supports without Training Provider Assurance Statement
DHS-6381-ENG (PDF) Substance Use Disorder (SUD) Services and Level of Care Assurance Statement
DHS-6696-ENG (PDF) MNsure Application for Health Coverage and Help Paying Costs
DHS-6696H-ENG (PDF) New Household Member or Applicant Request Form
DHS-6759P-ENG Moving Home Minnesota Service Authorization Plan
DHS-6762F-ENG (PDF) Structured Decision Making® (SDM®) Strengths and Needs Assessment
DHS-6893F-ENG (PDF) PCA Program Responsible Party Form/CFSS Participant's Representative Agreement
DHS-6893G-ENG (PDF) CFSS Program Information and Signature Sheet
DHS-6893L-ENG (PDF) Temporary CFSS Individual Service Delivery Plan Approval
DHS-6893W-ENG Lead Agency Addendum to CFSS Individual Service Delivery Plan (DHS-6893P)
DHS-8107-ENG SNAP Household Update Form [ HMN | RUS | SOM) | SPA) | VIE ]
DHS-8168-ENG Disability Services Division (DSD) Contact Form
DHS-8376-ENG SNAP Homeless Shelter Deduction Worksheet
DHS-8675-ENG (PDF) External Partner Conflict of Interest Disclosure Form
DHS-8675A-ENG (PDF) COI Disclosure Form for Competitive Grant Reviews
DHS-8750-ENG (PDF) Directed Pharmacy Dispensing Payment Provider Assurance Statement
DHS-3552-ENG Direct deposit for the Minnesota Child Care Assistance Program
DHS-4195-ENG CCAP Special Needs Rate Variance Request - County Recommendation Form
DHS-5191A-ENG Certified license exempt center – Short-term alternative location(s)
DHS-7124-ENG Child Foster Care or Adoption Background Study
DHS-7125-ENG Child Foster Care or Adoption Background Study
If you have questions, contact the eDocs Helpdesk.
In order to view PDF forms on eDocs, download the latest FREE version of Adobe Reader.
Please note that the following forms may have new web addresses. Web pages or other documents that link to these forms may need to be updated.
|
