Forms
Application for Social Services (DHS-2140) – English | Spanish | Somali
Change Report Form (DHS-2402) – English | Spanish | Somali
Child Care Assistance Application (DHS-3550) – English | Spanish | Somali
Child Care Assistance Change Report Form (DHS-4794) – English
Child Care Assistance Medical Condition Documentation Form (DHS-4602) – English
Combined Application Form (DHS-5223) – English | Spanish | Somali
Combined Application Form Addendum (DHS-5223C) – English | Somali
Combined Six Month Report (DHS-5576) – English | Spanish | Somali
Cooperation with Child Support Enforcement (DHS-2338) – English | Spanish | Somali
Direct Deposit for the Minnesota Child Care Assistance Program (DHS-3552) – English
DWP/MFIP Screening Questions (DHS-4026) – English
Employment Services Referral (DHS-3166) – English
Family Stabilization Services Pre-Sanction Checklist (DHS-6075) – English
Family Violence Referral (DHS-3323) – English
Financial Aid Information Form (DHS-2646) – English
Get Your Child Support Payments Faster, Safer, Easier (DHS-4533) – English | Spanish | Somali
Giving Permission for Someone to Act on My Behalf: MFPP (DHS-3437A) – English
Giving Permission for Someone to Act on My Behalf: Minnesota Health Care Programs (DHS-3437) – English
Health Plan Enrollment form for people under 65 (DHS-4106A) – English
Health Plan Enrollment form for non-disabled people under age 65 (DHS-4106B) – English
Healthcare Renewal (DHS-3418) – English | Spanish | Somali
Household Report Form (DHS-2120) – English | Spanish | Somali
Independent Living Plan (DHS-3801) – English
Information Minnesota Health Care Programs (DHS-3182) – English
MFIP Self-Screen (DHS-3482) – English | Spanish | Somali
Minnesota Family Planning Program Application (DHS-4740) – English | Spanish
Minnesota Family Planning Program Renewal (DHS-5440) – English
MNSure Application for Health Coverage (DHS-6741) – English | Spanish | Somali
MNSure Application for Health Coverage and Help Paying Costs (DHS-6696) – English | Spanish | Somali
NOITS (DHS-3175) – English
Nonreceipt/Replacement Affidavit (DHS-1609) – English
Notice of Requirement to Attend MFIP Overview (DHS-2929) – English
Notice of Requirement to Attend School (DHS-2961) – English
Observation Checklist (DHS-3483) – English
Problem-Oriented Screening Instrument for Teenagers (DHS-4141A) – English
Problem-Oriented Screening Instrument for Teenagers Scoring Sheet (DHS-4141B) – English
Problem-Oriented Screening Instrument for Teenagers Template (DHS-4141C) – English
Recognition of Parentage – English | Spanish | Somali
Referral of Minor Parent to Social Services (DHS-2882) – English
Referral to Support and Collections (DHS-3163B) – English | Spanish | Somali
Release of Employment Information (DHS-2146) – English
ROI General (DHS-3549) – English
ROI Shelter Expenses (DHS-2952) – English
School Attendance Verification (DHS-2883) – English
Section 811 Project Based Rent Assistance Pre-Application (DHS-7102) – English
SNAP Expedited Evaluation Form (DHS-4834) – English
Social Services Authorization for Release of Information – English
Special Learning Needs Brief Screening Tool (DHS-3504) – English
Special Learning Needs Scoring Form (DHS-3504A) – English
Status Update Form (DHS-3165) – English