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Documents
336
![Form C5 "Authorization to Obtain Income Information" - Minnesota](https://data.templateroller.com/pdf_docs_html/2250/22507/2250799/form-c5-authorization-to-obtain-income-information-minnesota.png "Form C5 "Authorization to Obtain Income Information" - Minnesota")
![Form DHS-7774 "Serious Injury Reporting Form - Family Child Care" - Minnesota](https://data.templateroller.com/pdf_docs_html/2080/20803/2080302/form-dhs-7774-serious-injury-reporting-form-family-child-care-minnesota.png "Form DHS-7774 "Serious Injury Reporting Form - Family Child Care" - Minnesota")
![Form DHS-3725 "Eft Vendor Number Notification" - Minnesota](https://data.templateroller.com/pdf_docs_html/2028/20284/2028437/form-dhs-3725-eft-vendor-number-notification-minnesota.png "Form DHS-3725 "Eft Vendor Number Notification" - Minnesota")
![Form DHS-4194 "Special Needs Rate Variance Request - Parent and Provider Request" - Minnesota](https://data.templateroller.com/pdf_docs_html/2028/20284/2028498/form-dhs-4194-special-needs-rate-variance-request-parent-and-provider-request-minnesota.png "Form DHS-4194 "Special Needs Rate Variance Request - Parent and Provider Request" - Minnesota")
![Form DHS-7740 "Grievance Procedure - Sample" - Minnesota](https://data.templateroller.com/pdf_docs_html/2028/20285/2028541/form-dhs-7740-grievance-procedure-sample-minnesota.png "Form DHS-7740 "Grievance Procedure - Sample" - Minnesota")
![Form DHS-5178 "Emergency Relative Placement Foster Care Referral Form" - Minnesota](https://data.templateroller.com/pdf_docs_html/2028/20285/2028513/form-dhs-5178-emergency-relative-placement-foster-care-referral-form-minnesota.png "Form DHS-5178 "Emergency Relative Placement Foster Care Referral Form" - Minnesota")
![Form DHS-4535 "Augmentative Communication Devices and Accessories Authorization Form" - Minnesota](https://data.templateroller.com/pdf_docs_html/2028/20284/2028450/form-dhs-4535-augmentative-communication-devices-and-accessories-authorization-form-minnesota.png "Form DHS-4535 "Augmentative Communication Devices and Accessories Authorization Form" - Minnesota")
![Form DHS-5086 "Iep/Ifsp Services Documentation Log" - Minnesota](https://data.templateroller.com/pdf_docs_html/2028/20284/2028460/form-dhs-5086-iep-ifsp-services-documentation-log-minnesota.png "Form DHS-5086 "Iep/Ifsp Services Documentation Log" - Minnesota")
![Form DHS-5510 "Authorization for Release of Child Support Information to a Third Party" - Minnesota](https://data.templateroller.com/pdf_docs_html/2028/20284/2028407/form-dhs-5510-authorization-for-release-of-child-support-information-to-a-third-party-minnesota.png "Form DHS-5510 "Authorization for Release of Child Support Information to a Third Party" - Minnesota")
![Form DHS4985 Part 1 "Crisis Response Services Primary Certification Application" - Minnesota](https://data.templateroller.com/pdf_docs_html/2028/20284/2028486/form-dhs4985-part-1-crisis-response-services-primary-certification-application-minnesota.png "Form DHS4985 Part 1 "Crisis Response Services Primary Certification Application" - Minnesota")
![Form DHS-2780 "Client Placement Authorization (CPA) - Ccdtf" - Minnesota](https://data.templateroller.com/pdf_docs_html/579/5791/579178/form-dhs-2780-client-placement-authorization-cpa-ccdtf-minnesota.png "Form DHS-2780 "Client Placement Authorization (CPA) - Ccdtf" - Minnesota")
![Instructions for Form ICPC-100B, DHS-4267-ENG "Interstate Compact on the Placement of Children Report on Child's Placement Status" - Minnesota](https://data.templateroller.com/pdf_docs_html/1823/18235/1823587/instructions-form-dhs-4267-eng-icpc-100b-interstate-compact-on-the-placement-children-report-on-child-s-placement-status.png "Instructions for Form ICPC-100B, DHS-4267-ENG "Interstate Compact on the Placement of Children Report on Child's Placement Status" - Minnesota")
![Form DHS-6633A "CDCs Community Support Plan Addendum With 2019/20 Budget Increases" - Minnesota](https://data.templateroller.com/pdf_docs_html/2028/20285/2028539/form-dhs-6633a-cdcs-community-support-plan-addendum-with-2019-20-budget-increases-minnesota.png "Form DHS-6633A "CDCs Community Support Plan Addendum With 2019/20 Budget Increases" - Minnesota")
![Form DHS-3163B "Referral to Support and Collections" - Minnesota](https://data.templateroller.com/pdf_docs_html/2028/20284/2028400/form-dhs-3163b-referral-to-support-and-collections-minnesota.png "Form DHS-3163B "Referral to Support and Collections" - Minnesota")
![Form DHS-7641R "Youth Exploitation or Trafficking Safety Plan" - Minnesota](https://data.templateroller.com/pdf_docs_html/2028/20284/2028431/form-dhs-7641r-youth-exploitation-or-trafficking-safety-plan-minnesota.png "Form DHS-7641R "Youth Exploitation or Trafficking Safety Plan" - Minnesota")
![Form DHS-7749A "Swimming Pool Permission Form" - Minnesota](https://data.templateroller.com/pdf_docs_html/2028/20283/2028384/form-dhs-7749a-swimming-pool-permission-form-minnesota.png "Form DHS-7749A "Swimming Pool Permission Form" - Minnesota")
![Form DHS-6810A "Positive Support Transition Plan Review" - Minnesota](https://data.templateroller.com/pdf_docs_html/2028/20284/2028432/form-dhs-6810a-positive-support-transition-plan-review-minnesota.png "Form DHS-6810A "Positive Support Transition Plan Review" - Minnesota")
![Form DHS-5849-EN "Nutritional Supplemental Authorization Request - Program Hh" - Minnesota](https://data.templateroller.com/pdf_docs_html/1823/18233/1823322/form-dhs-5849-en-nutritional-supplemental-authorization-request-program-hh-minnesota.png "Form DHS-5849-EN "Nutritional Supplemental Authorization Request - Program Hh" - Minnesota")
![Form DHS-4005-ENG "Telephone Equipment Distribution Program Application" - Minnesota](https://data.templateroller.com/pdf_docs_html/2267/22679/2267968/form-dhs-4005-eng-telephone-equipment-distribution-program-application-minnesota.png "Form DHS-4005-ENG "Telephone Equipment Distribution Program Application" - Minnesota")
![Form DHS-3539-ENG "Ryan White Annual Certification" - Minnesota](https://data.templateroller.com/pdf_docs_html/2206/22066/2206629/form-dhs-3539-eng-ryan-white-annual-certification-minnesota.png "Form DHS-3539-ENG "Ryan White Annual Certification" - Minnesota")
![Form DHS-3525-ENG "Application and Renewal Form for Medical Assistance for Women With Breast and Cervical Cancer (Ma-Bc)" - Minnesota](https://data.templateroller.com/pdf_docs_html/2190/21908/2190863/form-dhs-3525-eng-application-and-renewal-form-for-medical-assistance-for-women-with-breast-and-cervical-cancer-ma-bc-minnesota.png "Form DHS-3525-ENG "Application and Renewal Form for Medical Assistance for Women With Breast and Cervical Cancer (Ma-Bc)" - Minnesota")
![Form DHS-6562-ENG "Advisory Committee Application Form" - Minnesota](https://data.templateroller.com/pdf_docs_html/2080/20803/2080304/form-dhs-6562-eng-advisory-committee-application-form-minnesota.png "Form DHS-6562-ENG "Advisory Committee Application Form" - Minnesota")
![Form DHS-2402-ENG "Change Report Form" - Minnesota](https://data.templateroller.com/pdf_docs_html/2080/20803/2080300/form-dhs-2402-eng-change-report-form-minnesota.png "Form DHS-2402-ENG "Change Report Form" - Minnesota")
![Form DHS-3418-ENG "Minnesota Health Care Programs Renewal" - Minnesota](https://data.templateroller.com/pdf_docs_html/2209/22093/2209367/form-dhs-3418-eng-minnesota-health-care-programs-renewal-minnesota.png "Form DHS-3418-ENG "Minnesota Health Care Programs Renewal" - Minnesota")
![Formulario DHS-6696-SPA "Solicitud De Cobertura De Salud Y Ayuda Con El Pago De Costos" - Minnesota (Spanish)](https://data.templateroller.com/pdf_docs_html/2049/20495/2049526/formulario-dhs-6696-spa-solicitud-de-cobertura-de-salud-y-ayuda-con-el-pago-de-costos-minnesota-spanish.png "Formulario DHS-6696-SPA "Solicitud De Cobertura De Salud Y Ayuda Con El Pago De Costos" - Minnesota (Spanish)")
![Form DHS-6696-ENG "Application for Health Coverage and Help Paying Costs" - Minnesota](https://data.templateroller.com/pdf_docs_html/2028/20283/2028366/form-dhs-6696-eng-application-for-health-coverage-and-help-paying-costs-minnesota.png "Form DHS-6696-ENG "Application for Health Coverage and Help Paying Costs" - Minnesota")
![Form DHS-6428-ENG "Mhcp Synagis Authorization Form" - Minnesota](https://data.templateroller.com/pdf_docs_html/2010/20105/2010509/form-dhs-6428-eng-mhcp-synagis-authorization-form-minnesota.png "Form DHS-6428-ENG "Mhcp Synagis Authorization Form" - Minnesota")
![Form DHS-7775-ENG "Licensing Requirements Family Child Care" - Minnesota](https://data.templateroller.com/pdf_docs_html/2010/20105/2010534/form-dhs-7775-eng-licensing-requirements-family-child-care-minnesota.png "Form DHS-7775-ENG "Licensing Requirements Family Child Care" - Minnesota")
![Form DHS-3340-ENG "Asset Assessment for Medical Assistance for Long-Term Care Services (Ma-Ltc)" - Minnesota](https://data.templateroller.com/pdf_docs_html/2002/20022/2002287/form-dhs-3340-eng-asset-assessment-for-medical-assistance-for-long-term-care-services-ma-ltc-minnesota.png "Form DHS-3340-ENG "Asset Assessment for Medical Assistance for Long-Term Care Services (Ma-Ltc)" - Minnesota")
![Form DHS-7776-ENG "Family Child Care Admission and Arrangements" - Minnesota](https://data.templateroller.com/pdf_docs_html/2028/20285/2028587/form-dhs-7776-eng-family-child-care-admission-and-arrangements-minnesota.png "Form DHS-7776-ENG "Family Child Care Admission and Arrangements" - Minnesota")
![Form DHS-1958-ENG "Application for Support and Collections Services" - Minnesota](https://data.templateroller.com/pdf_docs_html/2028/20283/2028398/form-dhs-1958-eng-application-for-support-and-collections-services-minnesota.png "Form DHS-1958-ENG "Application for Support and Collections Services" - Minnesota")
Form DHS-1958-ENG "Application for Support and Collections Services" - Minnesota
Size: 1 MB
18 pages
![Formulario DHS-1958-SPA "Solicitud De Servicios De Manutencion Y Cobros" - Minnesota (Spanish)](https://data.templateroller.com/pdf_docs_html/2028/20283/2028394/formulario-dhs-1958-spa-solicitud-de-servicios-de-manutencion-y-cobros-minnesota-spanish.png "Formulario DHS-1958-SPA "Solicitud De Servicios De Manutencion Y Cobros" - Minnesota (Spanish)")
![Form DHS-1958-HMN "Full Child Support (IV-D) Services Application and Information on Child Support" - Minnesota (Hmong)](https://data.templateroller.com/pdf_docs_html/2028/20283/2028396/form-dhs-1958-hmn-full-child-support-iv-d-services-application-and-information-on-child-support-minnesota-hmong.png "Form DHS-1958-HMN "Full Child Support (IV-D) Services Application and Information on Child Support" - Minnesota (Hmong)")
![Form DHS-4060-ENG "Request to Close Support Case" - Minnesota](https://data.templateroller.com/pdf_docs_html/2010/20104/2010495/form-dhs-4060-eng-request-to-close-support-case-minnesota.png "Form DHS-4060-ENG "Request to Close Support Case" - Minnesota")
![Form DHS-3550-ENG "Minnesota Child Care Assistance Program Application" - Minnesota](https://data.templateroller.com/pdf_docs_html/2049/20495/2049596/form-dhs-3550-eng-minnesota-child-care-assistance-program-application-minnesota.png "Form DHS-3550-ENG "Minnesota Child Care Assistance Program Application" - Minnesota")
Form DHS-3550-ENG "Minnesota Child Care Assistance Program Application" - Minnesota
Size: 239 KB
27 pages
![Form DHS-3610-ENG "Children's Therapeutic Services and Supports (Ctss) Provider Application" - Minnesota](https://data.templateroller.com/pdf_docs_html/2078/20788/2078826/form-dhs-3610-eng-children-s-therapeutic-services-and-supports-ctss-provider-application-minnesota.png "Form DHS-3610-ENG "Children's Therapeutic Services and Supports (Ctss) Provider Application" - Minnesota")
![Form DHS-2977-ENG "Important Notice and Parental Fee Worksheet" - Minnesota, 2020](https://data.templateroller.com/pdf_docs_html/2028/20283/2028362/form-dhs-2977-eng-important-notice-and-parental-fee-worksheet-minnesota.png "Form DHS-2977-ENG "Important Notice and Parental Fee Worksheet" - Minnesota, 2020")
Form DHS-2977-ENG "Important Notice and Parental Fee Worksheet" - Minnesota, 2020
Size: 338 KB
6 pages
![Form DHS-7934-ENG "Family Child Care Child Enrollment Form" - Minnesota](https://data.templateroller.com/pdf_docs_html/2028/20285/2028593/form-dhs-7934-eng-family-child-care-child-enrollment-form-minnesota.png "Form DHS-7934-ENG "Family Child Care Child Enrollment Form" - Minnesota")
