 DHS-3525-ENG (PDF) Application and Renewal Form for Medical Assistance for People with Breast or Cervical Cancer (MA-BC)
DHS-3531-ENG (PDF) Application for Medical Assistance for Long-Term-Care Services (MA-LTC)
DHS-3539C-ENG (PDF) Ryan White Verification of Employer Insurance
DHS-3727-ENG (PDF) Combined Annual Renewal For Certain Populations
DHS-3876-ENG (PDF) Minnesota Health Care Programs Application for Certain Populations
DHS-3996-ENG (PDF) Injury Protection Program (IPP) - Participant Medical Referral and Medical Care Provider Information Letter
DHS-4005-ENG (PDF) Minnesota Access to Communication Technology Application
DHS-4106A-ENG Health plan enrollment form
DHS-4163-ENG (PDF) Client responsibilities and rights [ HMN (PDF) | RUS (PDF) | SOM (PDF) | SPA (PDF) | VIE (PDF) ]
DHS-4163L-ENG (PDF) Client responsibilities and rights (Large print)
DHS-4461-ENG Nursing Facility (NF) Communication Form
DHS-4583-ENG (PDF) Child Support Division - Request for Exception to Direct Deposit
DHS-4740-ENG (PDF) Minnesota Family Planning Program (MFPP) Application and Renewal Form
DHS-4794-ENG (PDF) Child Care Assistance Program (CCAP) – Change Report Form
[ HMN (PDF) | RUS (PDF) | SOM (PDF) | SPA (PDF) | VIE (PDF) ]
DHS-4813B-ENG (PDF) Child and Teen Checkups 2-Month Well Visit
DHS-4813E-ENG (PDF) Child and Teen Checkups 9-Month Well Visit
DHS-4813L-ENG (PDF) Child and Teen Checkups 4-Year Well Visit
DHS-4813M-ENG (PDF) Child and Teen Checkups 5-Year Well Visit
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-4813V-ENG (PDF) Child and Teen Checkups 15-Year Well Visit
DHS-5223F: Supplemental Nutrition Assistance Program (SNAP) Application for Seniors (Individuals and couples age 60 and older) [ HMN | RUS | SOM | SPA | VIE ]
DHS-5239F-ENG (PDF) Minnesota Family Planning Program Application and Renewal Form – Signature Page
DHS-5788E-ENG Consumer Directed Community Supports (CDCS) Coaching and Assistance
DHS-6125-ENG State Medical Review Team (SMRT) Disability Worksheet
DHS-6451B-ENG Non-Integrated Special Needs BasicCare (SNBC) Choice Form
DHS-6696-ENG (PDF) Application for Health Coverage and Help Paying Costs
[ HMN (PDF) | RUS (PDF) | SOM (PDF) | SPA (PDF) | VIE (PDF) ]
DHS-6696B-ENG (PDF) Supplement to the Minnesota Health Care Programs Application for Certain Populations [ HMN (PDF) | RUS (PDF) | SOM (PDF) ]
DHS-6696H-ENG (PDF) New Household Member or Applicant Request Form
DHS-6696I-ENG (PDF) Appendix D Work or Community Engagement
[ HMN (PDF) | RUS (PDF) | SOM (PDF) | SPA (PDF) | VIE (PDF) ]
DHS-6893T-ENG Worker Information form for CFSS budget model
DHS-7109-ENG EIDBI Individual Treatment Plan (ITP) and Progress Monitoring
DHS-7118-ENG License Application
DHS-7683-ENG (PDF) Accreditation Fee Reimbursement Request for Child Care Programs
DHS-8262-ENG (PDF) Minnesota Health Care Programs Renewal for Families, Children and Adults
DHS-8376-ENG SNAP Homeless Shelter Deduction Worksheet
DHS-8450-ENG (PDF) Guardian-Conservator Maltreatment and Licensing Agency Checks
DHS-8648-ENG Medical Assistance: Withdrawal of Claim From Probate
DHS-8776-ENG Request for more information – Early Intensive Developmental and Behavioral Intervention (EIDBI) Individual provider
DHS-8921-ENG Notice of Immediate Background Study Action Required Form
DHS-3891A Request for Early Intensive Developmental and Behavioral Intervention (EIDBI) NETStudy 2.0 Agency ID Number
DHS-5313A Targeted Review - Food Support ABAWD
DHS-5313C Case Review - Part II: FS/MFIP Case Management, Communication and Benefit Accuracy Review
DHS-5313D Targeted Review - Food Support Income
DHS-5313E Targeted Review - Food Support Non-Citizen
DHS-5313F Targeted Review - Food Support Shelter and Utilities
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