 DHS-4532-ENG (PDF) Notice of Denial for Public Assistance Applicants or Recipients
DHS-4677F-ENG ICF/DD Services During the Day Option
DHS-4905C-ENG (PDF) Extended Psychiatric Inpatient Initial Review
DHS-4905D-ENG (PDF) Extended Psychiatric Inpatient Weekly Bed Review
DHS-4905F-ENG (PDF) Extended Psychiatric Inpatient Discharge Summary Review
DHS-4915-ENG Medical Assistance (MA) Payment of Long-Term Care Services
DHS-5192-ENG (PDF) Legal Nonlicensed Provider Registration and Acknowledgment (Renewal Only)
DHS-5223-ENG Combined Application Form (HMN | RUS | SOM | SPA | VIE)
DHS-5223D-ENG Combined Application Form - Child Care Addendum (HMN | RUS | SOM | SPA | VIE)
DHS-5510-ENG (PDF) Authorization for Release of Child Support Information to a Third Party
DHS-5675-ENG (PDF) Electronic Claims Payment Affidavit
DHS-5815-ENG Alternative Care Program (AC) Application for Discretionary Services July 1-June 30 FY
DHS-6189H-ENG (PDF) Family Caregiver Services Provider Assurance Statement
DHS-6189I-ENG (PDF) Family Training and Counseling Provider Assurance Statement
DHS-6305-ENG (PDF) Child Care Assistance Program Parent Condition Form
DHS-6451-ENG Non-Integrated Special Needs BasicCare (SNBC) Choice Form
DHS-6451B-ENG Non-Integrated Special Needs BasicCare (SNBC) Choice Form
DHS-6523-ENG (PDF) Child Support Financial Statement
DHS-6683-ENG (PDF) Essential Community Supports Program (ECS) Eligibility Worksheet
DHS-6683A-ENG (PDF) Essential Community Supports Program (ECS) Eligibility Worksheet Type A
DHS-6790M-ENG RMS Worksheet – Day and Employment Services
DHS-6810J-ENG Plan for supporting communication growth
DHS-6826-ENG Essential Community Supports Program (ECS) Financial Disclosure Form
DHS-6893P-ENG CFSS Individual Service Delivery Plan
DHS-6939-ENG MA-EPD Good Cause Application
DHS-7109-ENG EIDBI Individual Treatment Plan (ITP) and Progress Monitoring
DHS-7118-ENG Office of Inspector General – License Application
DHS-7195-ENG (PDF) Minnesota Licensed Family Child Care Provider Registration and Acknowledgment (Renewal Only)
DHS-7196-ENG (PDF) CCAP Provider Registration Change Form
DHS-7583-ENG (PDF) Minnesota Child Care Assistance Programs Death, Serious Injury, Maltreatment Report Form
DHS-8057-ENG (PDF) Deaf, DeafBlind and Hard of Hearing State Services Division Client Intake Form
DHS-8159-ENG Supplemental Nutrition Assistance Program (SNAP) Work Rules Notice
DHS-8787-ENG (PDF) Elderly Waiver Customized Living Services Disproportionate Share Provider Attestation
DHS-8811-ENG Religious Accommodation Request Form
DHS-8814-ENG (PDF) Self-identification form
DHS-8817-ENG Respectful Workplace Policy Complaint Form
DHS-8818-ENG (PDF) Early Intensive Developmental and Behavioral Intervention (EIDBI) Licensing Pre-Application Checklist
DHS-8821-ENG (PDF) Comprehensive Assessment Individual Provider Assurance Statement
DHS-8823-ENG Request for Exception to 245D Licensing Moratorium
DHS-3863-ENG County and Tribal Nation MFIP Biennial Service Agreement
DHS-5776-ENG CCAP Integrated Full-Day Head Start Services Payment Application
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