 DHS-2128: Minnesota Health Care Programs Renewal for People Receiving Medical Assistance for Long-Term Care Services (MA-LTC) [ HMN (PDF) | ORM (PDF) | RUS (PDF) | SOM (PDF) | SPA (PDF) | VIE (PDF) ]
DHS-3482-ENG (PDF) MFIP Self-Screen
DHS-3543-ENG (PDF) MHCP Request for Payment of Long-Term Care Services
DHS-5192: Legal Nonlicensed Provider Registration and Acknowledgment (Renewal Only) [ HMN (PDF) | SOM (PDF) | SPA (PDF) ]
DHS-5223-ENG Combined Application Form
DHS-5788B-ENG (PDF) CDCS Behavioral Supports Request Form
DHS-5788C-ENG (PDF) CDCS Specialized Therapy Request Form
DHS-6189Z-ENG (PDF) Provider Not Required to Receive a 245D Program License – Provider Assurance Statement
DHS-6383-ENG (PDF) Lead Agency Assurance Statement: HCBS Provider Review and Approval
DHS-7102-ENG Section 811 Project Based Rent Assistance Pre-Application
DHS-8262: Minnesota Health Care Programs Renewal for Families, Children and Adults [ HMN (PDF) | RUS (PDF) | SOM (PDF) | SPA (PDF) | VIE (PDF) ]
DHS-8747-ENG (PDF) Recuperative Care Provider Pre-Enrollment Risk Assessment
DHS-5223E-ENG Program Change Request: Minnesota Transition Application Form
DHS-7601A-ENG Changes in Minnesota law affecting families receiving assistance from the Child Care Assistance Program
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