Minnesota Department of Human Services Forms
The Minnesota Department of Human Services is responsible for providing a wide range of services and benefits to residents of Minnesota. Some of the key areas they cover include healthcare and medical assistance, economic assistance programs, mental health and chemical dependency services, resources for individuals with disabilities, child welfare and protection, and services for the elderly and vulnerable populations. The department aims to promote the health and well-being of Minnesota residents by offering support and assistance in various areas of their lives.
Documents:
519
This form is used for creating a shared services agreement for home care in Minnesota. It is specifically for Personal Care Assistant (PCA) or Personal Directed Nurse (PDN) services.
PDF 
Word
This form is used for client placement authorization in Minnesota's Chemical Dependency Consolidated Treatment Fund (CDCTF) program.
This form is used for requesting an appeal with Mnsure, the health insurance marketplace in Minnesota.
This document lists child care centers in Minnesota.
This form is used for monthly safety inspections of cribs in child care centers in Minnesota to ensure a safe environment for children.
This document outlines the plan to reduce risks at child care centers in Minnesota.
This document is used for creating an agreement between an individual resident and a placement organization in Minnesota.
This form is used to apply for the Telephone Equipment Distribution (TED) Program in Minnesota.
This document is an application form for the Minnesota Family Planning Program. It is used to apply for the program and access family planning services in Minnesota.
This form is used for combining various applications related to Minnesota (Hmong) community.
This form is used for submitting a combined application in Minnesota specifically for individuals who are Somali speakers.
This Form is used for applying for combined services in Minnesota. The form is in Spanish.
This Form is used for applying for medical assistance for long-term care services in Minnesota.
This Form is used for renewing the Minnesota Family Planning Program in Minnesota.
This form is used for renewing long-term care services for individuals in Minnesota. It is specific to people who are receiving long-term care services and need to renew their eligibility.
This Form is used for requesting authorization for nutritional supplements under the Program Hh in Minnesota.
This form is used for applying for health coverage and financial assistance in Minnesota. It is specifically designed for the Somali-speaking community in the state.
This Form is used for applying for health coverage and financial assistance in Minnesota, specifically for the Hmong community.
This form is used for applying for health coverage and financial assistance to help cover the costs of healthcare in Minnesota. It is available in Vietnamese language for Vietnamese-speaking residents.
This Form is used for applying for health coverage and financial assistance in Minnesota, specifically for individuals who speak Russian.
This type of document is a combined application for child care addendum in Minnesota. It is used to provide additional information regarding child care services.
This form is used for reporting changes in personal information to the Department of Homeland Security in Minnesota. It is used to update records and ensure accurate data management.
This type of document is a Spanish version of the DHS-4740-SPA Form used to apply for the Minnesota Family Planning Program in Minnesota.
This form is used for conducting a diagnostic assessment for children and adolescents in Minnesota. It is specifically designed for healthcare providers to gather information and evaluate the mental health of young individuals.
This form is used for creating a treatment plan under the Youth Act in Minnesota.
This form is used for requesting the addition of a drug to the Minnesota Health Care Programs (MHCP) Home Health (HH) Drug Formulary.
This form is used for conducting a diagnostic assessment of a child or adolescent. Part I of the form is specifically designed for parents or caregivers to provide information about the child's background and behaviors. This form is used in the state of Minnesota.
This form is used for post adoption search information and is specific to Minnesota.
This Form is used for the Minnesota Adoption and Child Foster Care Application in Minnesota.
This Form is used for registering as an adoptive applicant in the State Adoption Exchange in Minnesota.
This form is used for Minnesota adoption and foster care purposes. It is an individual fact sheet that provides important information about a person involved in the adoption or foster care process in Minnesota.
This type of document is used for conducting an assessment of individuals or families who are interested in adopting or providing foster care for children in Minnesota.
Form DHS-4258E-ENG Minnesota Adoption and Child Foster Care Home Study Assessment Update - Minnesota
This form is used for updating the assessment of adoption and child foster care homes in Minnesota.
This form is used for requesting interstate placement of children in Minnesota.
This Form is used for providing information to attorneys or families who wish to file an adoption petition for children under the guardianship of the Commissioner of the Minnesota Department of Human Services in Minnesota.
This form is used for reporting the placement status of a child under the Interstate Compact on the Placement of Children in Minnesota.
