MFPP forms, documents and resources
Use only the Minnesota Family Planning Program (MFPP) approved forms and documents available on eDocs and through MN–ITS.
To apply to be a certified MFPP provider, see the Certified MFPP Provider Application packet (DHS-4773) (PDF).
Certified providers determining presumptive eligibility for MFPP
Give the MFPP Application and Renewal Form (DHS-4740) (PDF) to people who want to enroll in MFPP. Mail or fax the completed MFPP application and copies of any proofs collected when presumptive eligibility is determined to:
Minnesota Department of Human Services
PO Box 64960
St. Paul, MN 55164-0960
Forms available only in MN–ITS
Log in to MN–ITS
to access the following forms when determining presumptive eligibility:
- MFPP Short-Term Approval (DHS 5701A)
- MFPP Short-Term Denial (DHS 5701B)
- MFPP Rx Form – Fax short-term approval letters and Rx to pharmacies (front and back)