Minnesota Department of Human Services Forms

This Form is used for the assessment and management of persistent pain at clinics in Minnesota.

This form is used for obtaining authorization for the use of immunomodulator drugs in Minnesota.

This form is used for the Adult Day Treatment Contract Cover Sheet in Minnesota. It is used to provide information regarding the contract for adult day treatment services.

This form is used for applying to become an Adult Rehabilitative Health Services (ARMHS) provider in Minnesota.

This form is used for applying for a branch office location for Adult Rehabilitative Mental Health Services (ARMHS) in the state of Minnesota.

This form is used for recertification of Adult Rehabilitative Mental Health Services (ARMHS) in the state of Minnesota.

This form is used for authorizing adult mental health rehabilitative services in Minnesota.

This form is used for the certification requirements for providers of Adult Rehabilitative Mental Health Services (ARMHS) in Minnesota. It outlines the necessary qualifications and criteria that providers must meet to be certified.

This document is used in Minnesota for the recertification personnel record review for Adult Rehabilitative Mental Health Services (ARMHS).

This form is used for the recertification of recipients of Adult Rehabilitative Mental Health Services (ARMHS) in Minnesota.

This form is used for requesting a policy variance for Assertive Community Treatment (ACT) in the state of Minnesota.

This form is used for recording information in Minnesota. It is associated with the Department of Homeland Security (DHS) and is known as Form DHS-6249-ENG Locus Recording Form.

This Form is used for applying for re-certification of the Children's Therapeutic Services and Supports Community program in Minnesota.

This form is used for notifying the Department of Homeland Security of any changes in the state of Minnesota.

This form is used for adding additional information to the Children's Therapeutic Services and Supports program in Minnesota.

This document is used for assessing and creating service plans for teenage parents in the state of Minnesota. It helps in providing necessary support and resources to ensure the well-being of the adolescent parent and their child.

This form is used for entering into a voluntary foster care agreement for youth between the ages of 18 and 21 in Minnesota. It complies with the Minnesota Statutes, Chapter 260c.451.

This form is used for reporting the birth of a minor in Minnesota within 72 hours.

This form is used for private adoption agency staff in Minnesota to request membership on the Minnesota Adoption Email Listserv.

This form is used for the transfer of permanent legal and physical custody process checklist for children in county foster care in Minnesota.

This document is a checklist for the adoption process in Minnesota for children who are under the guardianship of the Commissioner. It provides guidance and ensures that all necessary steps are taken in the adoption process.

This form is used for revoking voluntary recognition of parentage in the state of Minnesota.

This form is used for revoking voluntary recognition of parentage in Minnesota for individuals belonging to the Hmong community.

This form is used for revoking voluntary recognition of parentage in Minnesota. It is specific to the Somali community.

This Form is used for revoking voluntary acknowledgment of paternity in Minnesota.

This form is used for revoking the non-parentage statement of a spouse in the state of Minnesota.

This Form is used for revoking a statement of non-parentage made by the spouse in Minnesota. It is specific to Somalis living in Minnesota.

Este formulario es utilizado para solicitar la revocación de la negación de paternidad por parte del esposo en el estado de Minnesota.

This document outlines the rights, responsibilities, and consent for individuals receiving Behavioral Health Home (BHH) services in Minnesota. It provides important information to ensure individuals understand their rights and responsibilities during their participation in BHH programs.

This form is used for notifying eligibility for Behavioral Health Home (BHH) Services in Minnesota.

This form is used for authorizing the release of protected health information for behavioral health home services in Minnesota.

This document is used for disclosing public testimony in Minnesota.

This form is used for modifying the Home and Community-Based Services (HCBS) Rights Support Plan in Minnesota. It serves as an attachment to the HCBS Rights Modification Support Plan.

This Form is used for requesting a hardship extension for Home and Community-Based Services (HCBS) provider attestation in Minnesota.

This document provides standardized items for assessing the functional abilities and skills of individuals during testing and training.

This form is used to report serious injuries and deaths that occur at a child care center in Minnesota.

This document is an Orientation Checklist for licensed child care centers in Minnesota. It is used to ensure that non-public child care centers are in compliance with state regulations and guidelines. The checklist covers various aspects such as health and safety, staff qualifications, program policies, and parent communication. It is an important tool for child care centers to ensure they provide a safe and quality environment for children.