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Forms
Printable application forms for health care programs
If you want to apply for Minnesota Health Care Programs (MHCP) on paper, it's important to ...
Date:
June
30, 2026
Health care coverage
IRS Form 1095-B for Certain Medical Assistance and MinnesotaCare Enrollees
The information on this page is about the Internal Revenue Service ( ...
Description: The information on this page is about the Internal Revenue Service (IRS) Form 1095-B, Health Coverage, for 2021. For tax year 2021, you do not need the form 1095-B to complete an income tax return.
Date:
June
26, 2026
Publications, forms and resources
Publications, forms and resources
Key resources to connect you quickly to the services, documents and information you need including a wide variety of ...
Date:
July
08, 2026
Publications, forms and resources
Family Medical Leave Act forms
Minnesota Department of Human Services employees who are absent from ... Resources leave coordinator
Family Medical Leave Act (FMLA) forms
Employee Certification of Health Care Provider (PDF)
Employee ...
Description: Family Medical Leave Act (FMLA) forms for DHS employees.
Date:
March
09, 2016
Minnesota Family Planning Program (MFPP) forms, documents and resources
Use only the MFPP approved forms and documents available on eDocs and through MN–ITS. To apply to ...
Description: Providers must use only the Minnesota Family Planning Program (MFPP) approved forms and documents available on eDocs and through MN–ITS.
Date:
June
26, 2026
Publications, forms and resources
Common application forms
Find commonly used application forms and application information for human services programs. Find the searchable document library, online and paper applications and ...
Description: This page features a list of links to common application forms or application information for human services programs.
Date:
July
08, 2026
Adult mental health
County of Financial Responsibility Dispute form
The County of Financial Responsibility Dispute form is ... Health Fund services.
Access and submit the dispute form
If you are a Tribe or County that ...
Date:
July
07, 2026
HPE: Policies, forms and notices
HPE main page | Policies, forms and notices | Training | FAQs | Contact us Hospitals participating in the Hospital ... MN–ITS to verify past coverage through HPE
Forms
HPE application
Use the HPE Application (DHS-3881) ( ...
Description: The following policy and procedure guides, forms and notices are used by hospitals participating in the Hospital Presumptive Eligibility (HPE) program.
Date:
July
07, 2026
HPE: Unique Key Request Form
HPE main page | Policies, forms and notices | Training | FAQs | Contact us Please check the Unique key search before completing and ... out my online form .
HPE: Unique Key Request Form
HPE main page | Policies, forms and notices | Training | ...
Description: Use this form to request a unique key to take the HPE online training.
Date:
July
07, 2026
New Drugs and New or Nonpreferred Dosage Forms
Drug - New Drugs and New or Nonpreferred Dosage Forms November 2018 New drugs New dosage forms Nonpreferred dosage forms New fixed-dose combinations ...
Description: This is the prior authorization (PA) criteria for coverage of this drug under Minnesota Health Care Programs (MHCP).
Date:
June
26, 2026