 DHS-0188-ENG Post-placement Assessment and Report to Court
DHS-2128-ENG (PDF) Minnesota Health Care Programs Renewal for People Receiving Medical Assistance for Long-Term Care Services (MA-LTC)
DHS-2243-ENG MHCP Authorization for Release of Information About Assets
DHS-2708-ENG Community Minnesota Supplemental Aid Budget Worksheet
DHS-2776C-ENG Computation of DWP Overpayment Worksheet
DHS-2807-ENG (PDF) Civil Rights Complaint Form: Discrimination in Service Delivery
DHS-3132A-ENG (PDF) Request for Provider Administrative Disqualification Hearing
DHS-3163B-ENG (PDF) Referral to support and collections
DHS-3164-ENG (PDF) Income withholding-only (Non-IV-D) services application for support order processing
DHS-3271: Minnesota Health Care Programs Request for Information
(HMN | ORM | RUS | SOM | SPA | VIE)
DHS-3539-ENG Ryan White Program Application
DHS-3539B-ENG Ryan White New Applicant Form
DHS-3539F-ENG Ryan White Information Change Form
DHS-3539Z-ENG Ryan White Program Application – Attachments
DHS-3627-ENG (PDF) Important information about your request for a Child Support Good Cause Exemption
DHS-3628-ENG (PDF) Notice of denial of child support good cause exemption
DHS-3767-ENG Request for Group Health Plan Information
DHS-3767B-ENG Request for Individual Health Plan Information (SOM | SPA)
DHS-3907-ENG MHCP Information Needed for Reported Change(s)
DHS-4621-ENG MHCP Medical Support Referral
DHS-4839K-ENG (PDF) Notice of Privacy Practices and Rights and Responsibilities for DHS-6696/6696B [ HMN (PDF) | ORM (PDF) | RUS (PDF) | SOM (PDF) | SPA (PDF) | VIE (PDF) ]
DHS-4939-ENG Notice of MinnesotaCare Overpayment
DHS-5223C: Combined Application - Addendum (For SNAP (food) and cash assistance programs)
[ HMN (PDF) | RUS (PDF) | SOM (PDF) | SPA (PDF) | VIE (PDF) ]
DHS-6020-ENG Supplemental Nutrition Assistance Program (SNAP) Employment and Training Plan
DHS-6189CC-ENG (PDF) Personal Emergency Response System Provider Assurance Statement
DHS-6696: MNsure Application for Health Coverage and Help Paying Costs
[ HMN (PDF) | ORM (PDF) | RUS (PDF) | SOM (PDF) | SPA (PDF) | VIE (PDF) ]
DHS-6696B-ENG (PDF) Supplement to the Minnesota Health Care Programs Application for Certain Populations
DHS-6696D-ENG (PDF) Appendix A - Health Coverage from Jobs
[ HMN (PDF) | ORM (PDF) | RUS (PDF) | SOM (PDF) | SPA (PDF) | VIE (PDF) ]
DHS-6696G-ENG (PDF) Medical Assistance (MA) Inpatient Hospital Coverage for Incarcerated People
DHS-6791A-ENG (PDF) MnCHOICES Assessment Summary Worksheet
DHS-6811-ENG (PDF) Child Care Provider Investigations Communication Form
DHS-6893L-ENG (PDF) Temporary CFSS Individual Service Delivery Plan Approval
DHS-7120A-ENG (PDF) Early Intensive Developmental and Behavioral Intervention (EIDBI) Comprehensive Multi-Disciplinary Evaluation (CMDE) Provider Assurance Statement
DHS-7645B-ENG (PDF) EIDBI Benefit: Provider agency rights and responsibilities
DHS-8105-ENG Medical Assistance Overpayment Calculation
DHS-8132-ENG Supplement to Family (Individual) Application
DHS-8159-ENG Supplemental Nutrition Assistance Program (SNAP) Work Rules Notice
DHS-8262-ENG (PDF) Minnesota Health Care Programs Renewal for Families, Children and Adults
DHS-8456-ENG (PDF) SNAP Work Rules Screening Questions
DHS-8786-ENG (PDF) Primary Medical Provider’s Documentation of Developmental Disabilities Medical Evaluation Summary
DHS-8812-ENG (PDF) Designation as a Tribal Federally Qualified Health Center (FQHC) in Minnesota Health Care Programs (MHCP)
DHS-4608: Child and Teen Checkups Intro Letter (HMN, RUS, SOM, SPA, VIE)
DHS-4608A: Child and Teen Checkups Renotification Letter (HMN, RUS, SOM, SPA, VIE)
DHS-4608C: Child and Teen Checkups Reminder Letter for Parents under 21 (HMN, RUS, SOM, SPA, VIE)
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