4072
This form is used for enrolling as an Individual Direct Support Worker in Minnesota Health Care Programs for Consumer Directed Community Supports (CDCs) and Consumer Support Grant (CSG).
This document is used for assigning payment for day training and habilitation services under the Minnesota Health Care Programs (MHCP) in Minnesota.
This form is used to apply for enrollment as a housing stabilization services provider for the Minnesota Health Care Programs (MHCP) in Minnesota.
This document is used for Minnesota Health Care Programs (MHCP) to provide an assurance statement for Adult Companion Services or Individualized Home Supports without training provider.
This form is used for submitting an assurance statement for Independent Living Skills Therapy Provider regarding Minnesota Health Care Programs in Minnesota.
This form is used for requesting a hardship exemption for Minnesota Health Care Programs (MHCP). It is specifically for residents of Minnesota who are facing financial difficulties and need assistance with their healthcare expenses.
This form is used for designating a billing person for home and community-based services waiver or alternative care in Minnesota Health Care Programs (MHCP). It is necessary for managing billing and financial aspects of these services.
This form is used for Lead Agencies in Minnesota Health Care Programs to provide assurance statements for the review and approval of HCBS (Home and Community-Based Services) providers.
This form is used for the Community First Services and Supports (CFSS) Assurance Statement for Consultation Services Lead Employee in Minnesota Health Care Programs (MHCP). It is required for individuals providing consultation services under the CFSS program.
This Form is used for Positive Supports Provider Assurance Statement in Minnesota Health Care Programs (MHCP) in Minnesota.
This form is used for adding additional information to a provider entity sale or transfer in the Minnesota Health Care Programs (MHCP).
This form is used for respite providers with a 245d or 144a license who are providing services in an unlicensed setting under the Minnesota Health Care Programs (MHCP). It includes an assurance statement.
This form is used for providers of specialized equipment and supplies to assure compliance with Minnesota Health Care Programs (MHCP) in Minnesota.
This document is used for monitoring food banks in Minnesota that participate in the TEFAP program. It helps ensure compliance and track the distribution of food to those in need.
This Form is used for monitoring the distribution of emergency food assistance through the TEFAP program in Minnesota.
This Form is used for transferring emergency food assistance through the TEFAP program in Minnesota.
This form is used for reporting monthly adjustments to the TEFAP program in the state of Minnesota.
This document is used for reporting incidents related to the Emergency Food Assistance Program (TEFAP) in Minnesota.
This document is used for conducting a basic assessment of visual acuity and vision impairments in individuals with low vision in the state of Minnesota.
This form is used for assessing adult disability in the state of Minnesota by the State Medical Review Team (SMRT).
This form is used for the Children's Continuing Disability Review (CDR) process in Minnesota. It is specifically designed for the State Medical Review Team (SMRT) to assess the ongoing eligibility of children with disabilities for government assistance programs.
This Form is used for the State Medical Review Team (SMRT) in Minnesota to assess the disability status of children.
This form is used for authorizing the State Medical Review Team in Minnesota to release protected health information.
This document is for the State Medical Review Team (SMRT) conducting adult continuing disability reviews in Minnesota. It is used to gather information about the individual's medical condition and determine their eligibility for disability benefits.
This form is used for obtaining general consent and authorization to release information in the state of Minnesota.
This form is used for documenting an individual's education and work history in the state of Minnesota.
This form is used for applying for Qualified Small Business Certification under the Angel Tax Credit Program in Minnesota. It provides instructions on how to complete the application and apply for the program.
This document provides instructions for completing the Qualified Small Business Annual Report for the Angel Tax Credit Program in Minnesota. It outlines the requirements and details needed for reporting on the program's tax credits.
This document is a checklist for qualified small businesses in Minnesota to apply for the Angel Tax Credit Program. It provides step-by-step instructions and requirements to determine eligibility for the program.
This document is an application for a USB breath switch adaptor in Minnesota. It is used for requesting a USB device that can be used as a switch by breathing into it.
This form is used for conducting a pre-award risk assessment in the state of Minnesota.