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This version of the form is not currently in use and is provided for reference only. Download this version of
Form DHS-4015-ENG
for the current year.
Form DHS-4015-ENG Home and Community Based Services (Hcbs) - Provider Enrollment Application - Minnesota Health Care Programs (Mhcp) - Minnesota
What Is Form DHS-4015-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 the DHS-4015-ENG form?
A: The DHS-4015-ENG form is the Provider Enrollment Application for Home and Community Based Services (HCBS) under Minnesota Health Care Programs (MHCP) in Minnesota.
Q: What is the purpose of the form?
A: The purpose of the form is to enroll providers in the Home and Community Based Services program under Minnesota Health Care Programs.
Q: Who needs to fill out this form?
A: Providers who wish to participate in the Home and Community Based Services program under Minnesota Health Care Programs need to fill out this form.
Q: What are Home and Community Based Services?
A: Home and Community Based Services are a range of support services provided to individuals in their homes or communities to help them stay independent.
Q: What are Minnesota Health Care Programs?
A: Minnesota Health Care Programs refer to the various state-funded healthcare programs offered to eligible individuals in Minnesota.
Form Details:
- Released on November 1, 2021;
- 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-4015-ENG by clicking the link below or browse more documents and templates provided by the Minnesota Department of Human Services.
Download Form DHS-4015-ENG Home and Community Based Services (Hcbs) - Provider Enrollment Application - Minnesota Health Care Programs (Mhcp) - Minnesota
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