Minnesota Department of Human Services Forms

This form is used for employment mentor inquiries in Minnesota.

This Form is used for applying to become a Children's Therapeutic Services and Supports (CTSS) provider in the state of Minnesota.

This form is used for reporting serious injuries that occur in family child care facilities in the state of Minnesota.

This form is used for reporting critical incidents involving children in the state of Minnesota. It allows for the documentation of important details related to incidents that may impact the wellbeing and safety of children.

This form is used for applying to join an advisory committee in Minnesota.

This form is used for obtaining consent from a guardian or conservator in Minnesota. It is required for certain legal matters involving an individual who is under guardianship or conservatorship.

This form is used for renewing Minnesota Health Care Programs in Minnesota.

This Form is used for authorizing someone to obtain income information in the state of Minnesota.

This form is used for screening eligibility for Supplemental Nutrition Assistance Program (SNAP) benefits in Minnesota. It is specifically designed for Russian-speaking individuals.

This document is used for applying for Supplemental Nutrition Assistance Program (SNAP) benefits in Minnesota. It is specifically designed for Somali speakers.

This document is for applying for the Supplemental Nutrition Assistance Program (SNAP) benefits in Minnesota. It helps eligible individuals stretch their money for food. (Spanish)

This form is used for reporting deaths or serious injuries that occur in Minnesota. It is important for law enforcement and relevant authorities to be notified of such incidents for investigation and record-keeping purposes. The form collects details related to the incident, such as the individuals involved, the location, and the cause of death or injury.

This form is used for notifying contracted per diem rates in Minnesota.

This form is used for requesting a new account in Minnesota.

Este formulario se utiliza para solicitar una cuenta en Minnesota.

This form is used for requesting a new account in Minnesota, specifically for Hmong individuals.

This document is a consent form that is used for conducting background studies in Minnesota through the NetStudy 2.0 system. It outlines the purpose of the study and asks for permission to gather relevant information for evaluation purposes.

This form is used for conducting background studies on certified child care centers in Minnesota. It helps gather relevant information and ensure the safety and well-being of children in these facilities.

This form is used for conducting background studies on individuals working in child care centers in Minnesota.

This Form is used for requesting electronic remittance advice (RA) for Minnesota Health Care Programs (MHCP) in Minnesota.

This Form is used for Qualified Professionals (QPs) in Minnesota Health Care Programs (MHCP) to acknowledge their role and responsibilities.

This Form is used for providers in Minnesota Health Care Programs (MHCP) to make an addendum to their provider agreement.

This document is for individuals applying for medical assistance in Minnesota. It is a presumptive eligibility agreement form for the Minnesota Health Care Programs.

This document is used for Child and Teen Checkups (C&tc) providers in Minnesota to enter into an agreement with the Minnesota Health Care Programs (Mhcp).

This type of document is used for the Icf/DD Training and Habilitation Agreement under the Minnesota Health Care Programs (MHCP) in Minnesota.

This Form is used for providers in Minnesota Health Care Programs (MHCP) to submit an assurance statement for supported employment services related to moving home in Minnesota.