Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota

Notification Icon This version of the form is not currently in use and is provided for reference only. Download this version of Form DHS-6696-ENG for the current year.

Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota

What Is Form DHS-6696-ENG?

This is a legal form that was released by the Minnesota Department of Human Services - a government authority operating within Minnesota. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is DHS-6696-ENG?
A: DHS-6696-ENG is the application form for health coverage and help paying costs in Minnesota.

Q: Who is eligible to use DHS-6696-ENG?
A: Residents of Minnesota who need health coverage and financial assistance can use this application form.

Q: What does DHS-6696-ENG cover?
A: DHS-6696-ENG helps individuals apply for various health coverage programs and financial support in Minnesota.

Q: How do I fill out DHS-6696-ENG?
A: Read the instructions carefully and provide accurate information about yourself, your income, and your household members. Follow the guidelines for required documentation.

Q: What do I do after filling out DHS-6696-ENG?
A: Submit the completed application form to the appropriate office as instructed in the application.

Q: How long does it take to process DHS-6696-ENG?
A: Processing times for DHS-6696-ENG may vary, but you should receive a notice of eligibility or denial within a few weeks.

Q: What if my application is denied?
A: If your application is denied, you will receive a notice explaining the reasons for the denial. You may have the option to appeal the decision.

Q: Can I get help filling out DHS-6696-ENG?
A: Yes, you can seek assistance from trained navigators, brokers, or other community organizations to help you complete the application form.

Q: Are there any fees for DHS-6696-ENG?
A: No, there are no fees to submit the DHS-6696-ENG application form.

ADVERTISEMENT

Form Details:

  • Released on November 1, 2019;
  • The latest edition provided by the Minnesota Department of Human Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DHS-6696-ENG by clicking the link below or browse more documents and templates provided by the Minnesota Department of Human Services.

Download Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota

4.7 of 5 (22 votes)
  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota

    1

  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 2

    2

  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 3

    3

  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 4

    4

  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 5

    5

  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 6

    6

  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 7

    7

  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 8

    8

  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 9

    9

  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 10

    10

  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 11

    11

  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 12

    12

  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 13

    13

  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 14

    14

  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 15

    15

  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 16

    16

  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 17

    17

  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 18

    18

  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 19

    19

  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 20

    20

  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 21

    21

  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 22

    22

  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 23

    23

  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 24

    24

  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 25

    25

  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 26

    26

  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 27

    27

  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 28

    28

  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 29

    29

  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 30

    30

  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 31

    31

  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 32

    32

  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 33

    33

  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 34

    34

  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 35

    35

  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 36

    36

  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 1
  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 2
  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 3
  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 4
  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 5
  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 6
  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 7
  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 8
  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 9
  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 10
  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 11
  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 12
  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 13
  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 14
  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 15
  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 16
  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 17
  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 18
  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 19
  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 20
  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 21
  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 22
  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 23
  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 24
  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 25
  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 26
  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 27
  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 28
  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 29
  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 30
  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 31
  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 32
  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 33
  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 34
  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 35
  • Form DHS-6696-ENG Application for Health Coverage and Help Paying Costs - Minnesota, Page 36
Prev 1 2 3 4 5 ... 36 Next
ADVERTISEMENT

Related Documents