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IRS Form 1095-B for Certain Medical Assistance and MinnesotaCare Enrollees
The information on this page is about the ... available upon request only
DHS will mail the form only when requested by Medical Assistance and MinnesotaCare ...
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:
December
31, 2024
Family Medical Leave Act forms
Minnesota Department of Human Services employees who are absent from work for four or more consecutive days because of an ... or local HR Office to initiate paperwork. FMLA forms Employee Certification of Health Care Provider (PDF) Family ...
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:
October
15, 2025
Printable application forms for health care programs
If you want to apply for Minnesota Health Care Programs (MHCP) on paper, it' ... or the Screen Our Circle Program .
Printable application forms for health care programs
If you want to ...
Description: Find out who should use a paper application to apply for Minnesota Health Care Programs.
Date:
February
04, 2026
Renewal forms for health care programs
We need to review your information at certain times to see whether you ... Cervical Cancer coverage renewal (DHS-3525) (PDF)
Renewal forms for health care programs
We need to review ...
Description: Find select Minnesota Health Care Programs renewal forms that you can print out if you lose the one you got in the mail.
Date:
February
04, 2026
Printable application forms for health care programs
If you want to apply for Minnesota Health Care Programs (MHCP) on paper, it' ... or the Screen Our Circle Program .
Printable application forms for health care programs
If you want to ...
Description: Find out who should use a paper application to apply for Minnesota Health Care Programs.
Date:
February
04, 2026
Renewal forms for health care programs
We need to review your information at certain times to see whether you ... Cervical Cancer coverage renewal (DHS-3525) (PDF)
Renewal forms for health care programs
We need to review ...
Description: Find select Minnesota Health Care Programs renewal forms that you can print out if you lose the one you got in the mail.
Date:
February
04, 2026
Renewal forms for health care programs
We need to review your information at certain times to see whether you ... Health Care Programs Renewal DHS-3418 (PDF)
Renewal forms for health care programs
We need to review ...
Description: Find select Minnesota Health Care Programs renewal forms that you can print out if you lose the one you got in the mail.
Date:
June
20, 2023
Renewal forms for health care programs
We need to review your information at certain times to see whether you ... Health Care Programs Renewal DHS-3418 (PDF)
Renewal forms for health care programs
We need to review ...
Description: Find select Minnesota Health Care Programs renewal forms that you can print out if you lose the one you got in the mail.
Date:
June
20, 2023
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:
February
04, 2026