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