 DHS-2146-ENG Authorization for Release of Employment Information
DHS-2402-ENG (PDF) Change Report Form For Cash Programs
DHS-2402B: Change Report Form for the Supplemental Nutrition Assistance Program
[ HMN (PDF) | RUS (PDF) | SOM (PDF) | SPA (PDF) | VIE (PDF) ]
DHS-2825-ENG (PDF) Notice of Contracted Per Diem Rates
DHS-2883-ENG MDHS Request for Verification of School Attendance/Progress
DHS-3418-ORM (PDF) Minnesota Health Care Programs Renewal
DHS-3543A-ENG (PDF) MHCP Payment of Long-Term Care Services (Families with Children and Adults)
DHS-3727: Combined Annual Renewal For Certain Populations [ HMN (PDF) |
RUS (PDF) | SOM (PDF) | SPA (PDF) | VIE (PDF) ]
DHS-3883-ENG (PDF) SMRT Education and Work History
DHS-4296-ENG (PDF) Opioid Treatment Program Central Registry, General Consent/Authorization for Release of Information
DHS-5190-ENG (PDF) Minnesota Child Care Assistance Programs Licensed Center Provider Registration and Acknowledgment
DHS-5191-ENG (PDF) Minnesota Child Care Assistance Programs License Exempt Provider Registration and Acknowledgment
DHS-5223F: Supplemental Nutrition Assistance Program (SNAP) Application for Seniors (Individuals and couples age 60 and older) (HMN | RUS | SOM | SPA | VIE)
DHS-6124-ENG (PDF) SMRT Authorization to Release Protected Health Information
DHS-6696H-ENG (PDF) New Household Member or Applicant Request Form
DHS-6751T-ENG (PDF) Early Intensive Developmental and Behavioral Intervention (EIDBI) Training Checklists
DHS-6873-SPA (PDF) Authorization for Release of Information for the Successful Life Project
DHS-7109-ENG EIDBI Individual Treatment Plan (ITP) and Progress Monitoring
DHS-7109A-ENG EIDBI transition and/or discharge summary
DHS-7120C-ENG (PDF) Early Intensive Developmental and Behavioral Intervention (EIDBI) Qualified Supervising Professionals (QSP) Assurance Statement
DHS-7645B-ENG (PDF) EIDBI Benefit: Provider agency rights and responsibilities
[ CHS (PDF) | HMN (PDF) | KAR (PDF) | ORM (PDF) | RUS (PDF) | SOM (PDF) | SPA (PDF) | VIE (PDF) ]
DHS-7868-ENG (PDF) Student Enrollment Statement for SNAP E&T
DHS-8823-ENG Request for Exception to 245D Licensing Moratorium
DHS-8838-ENG Request for Exception to Adult Day Care Licensing Moratorium
DHS-2727A-ENG Instructions to complete the Long-Term Services and Supports Assessment and Program Information and Signature Sheet
DHS-3427T-ENG LTC Screening Document - Telephone Screening
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