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APPLYMN Intake7 documents

  • Wabasha County Cover Letter
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    Wabasha County Cover Letter
  • Food Support Reporting Responsibilities
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    Brochure explaining the reporting responsibilities for the Supplemental Nutrition Assistance Program (SNAP).
  • Facts on Voluntarily Quitting Your Job
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    Fact sheet informing clients of the Supplemental Nutrition Assistance Program (SNAP) penalties for voluntarily quitting a job without good reasons.
  • Work Registration Notice
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    This notice explains the work requirements for Mandatory Work Registrants of the SNAP program and is given to new applicants and recipients at recertification. Eligibility workers should provide this notice and verbally explain the work requirements of the SNAP program.
  • What is Six-Month Reporting
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    Brochure describing six month reporting and how it works.
  • Customer Satisfaction Survey
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    Survey of how well we provided service to you.
  • Community Resource Booklet
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Asset Assessment3 documents

  • Asset Assessment Fact Sheet
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  • Asset Assessment for MA and Payment of LTC Services
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  • Customer Satisfaction Survey
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Child Care for Client15 documents

  • MN CCAP Program Family Guide
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  • Child Care Assistance Program Application
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  • CCAP & Fraud - Q & A for Families
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  • Client Rights & Responsibilities
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  • Do You Need Help Paying for Child Care Brochure
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  • Parent Acknowledgement When Choosing LNL Provider
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  • Reporting Responsibilities for CCAP Families
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  • Notice of Privacy Practices
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  • Do You Have a Disability Brochure
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  • Health & Safety Resource List for Parents and LNL Providers
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  • CCAP Payments for Child of Center Employees - Q & A for Parents
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  • Death, Serious Injury, & Maltreatment Report Form
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  • Customer Satisfaction Survey
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  • Child Care Assistance Program Application Cover Letter
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  • CCAP Asset Attestation Letter
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Child Care Provider Packet for Legal Non-Licensed23 documents

  • CC Provider Rights and Responsibilities
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  • CCAP Provider Guide
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  • CC Notice of Privacy Practices for Providers
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  • Direct Deposit for MN CCAP
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  • CCAP Financial Tracking Form
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  • MN CCAP Program Change Form
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  • LNL Provider Registration and Acknowledgement
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  • Health & Safety Resource List for Parents and LNL Providers
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  • Keeping Children Safe in Your Home
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  • Health and Safety Best Practices
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  • Provider Emergency Planning Guide
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  • Local Emergency Contacts
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  • Child Emergency Contact Information
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  • LNL Emergency Plan
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  • Death, Serious Injury, & Maltreatment Report Form
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  • LNL First Aid Training Q&A
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  • LNL Provider Training Acknowledgement
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  • Notice of Practices for Providers
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  • Important Information - Appeals
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  • Background Study Data Collection Form
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  • W-9 IRS Request for TIN and Certification
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  • Child Care Assistance Provider Cover Letter
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  • Customer Satisfaction Survey
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Child Care Provider Packet for Licensed Centers16 documents

  • Child Care Assistance Provider Cover Letter
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  • CC Provider Rights and Responsibilities
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  • CCAP Provider Guide
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  • CC Notice of Privacy Practices for Providers
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  • Direct Deposit for MN CCAP
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  • CCAP Financial Tracking Form
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  • MN CCAP Change Form
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  • W-9 IRS Request for TIN and Certification
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  • Licensed Provider Registration & Acknowledgement
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  • Important Information for Child Care Providers
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  • Notice of Privacy Practices for Child Care Providers
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  • Child Care Center Employer Responsibilities
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  • Child Care Center Employee Rights & Responsibilities
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  • CCAP & Fraud - Q & A for Child Care Centers
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  • CCAP Payments for Children of Center Employees - Q & A
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  • Customer Satisfaction Survey
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Child Care Provider Packet for Licensed Exempt14 documents

  • Child Care Assistance Provider Cover Letter
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  • CC Provider Rights and Responsibilities
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  • CCAP Provider Guide
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  • CC Notice of Privacy Practices for Providers
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  • Direct Deposit for MN CCAP
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  • CCAP Financial Tracking Form
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  • MN CCAP Change Form
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  • W-9 IRS Request for TIN and Certification
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  • Licensed Provider Registration & Acknowledgement
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  • Important Information for Child Care Providers
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  • Notice of Privacy Practices for Child Care Providers
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  • Keeping Children Safe: CCAP Emergency Planning Guide
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  • Child Care Emergency Plan
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  • Customer Satisfaction Survey
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Child Care Provider Packet for Licensed Family Provider13 documents

  • Child Care Assistance Provider Cover Letter
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  • CC Provider Rights and Responsibilities
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  • CCAP Provider Guide
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  • CC Notice of Privacy Practices for Providers
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  • Direct Deposit for MN CCAP
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  • CCAP Financial Tracking Form
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  • MN CCAP Change Report Form
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  • W-9 IRS Request for TIN and Certification
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  • Licensed Provider Registration & Acknowledgement
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  • Important Information for Child Care Providers
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  • Authorization for Release of Information from BCA
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  • Notice of Privacy Practices for Child Care Providers
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  • Customer Satisfaction Survey
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Child Support Packet3 documents

  • Understanding Child Support Booklet
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  • Referral to Support & Collections
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  • Cooperation with Child Support Enforcement
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Combined Application Form Packet (English)12 documents

  • Wabasha County Cover Letter
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    Wabasha County Cover Letter
  • Combined Application Form
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    The Combined Application Form is used to gather the information needed to determine eligibility for all Minnesota Department of Human Services cash programs and SNAP (food assistance). This form is also used for the recertification of cash and SNAP programs.
  • Program Information for Cash, Food, Child Care, and Health Care Programs
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    Brochure explaining the various programs the Department of Human Services manages, who is eligible for those programs and how to apply for them.
  • Domestic Violence Information
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    Brochure explaining domestic violence and abuse and how victims can get a waiver from some of the DWP, MFIP and Supplemental Nutrition Assistance Program (SNAP) rules.
  • Do You Have a Disability Brochure
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    Brochure explaining the rights that people with disabilities have and the kind of help that is available to them.
  • Food Support Reporting Responsibilities
    document seq 0.00
    Brochure explaining the reporting responsibilities for the Supplemental Nutrition Assistance Program (SNAP).
  • Facts on Voluntarily Quitting Your Job
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    Fact sheet informing clients of the Supplemental Nutrition Assistance Program (SNAP) penalties for voluntarily quitting a job without good reasons.
  • How to Use Your Minnesota EBT Card
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    Booklet explaining how to use the Minnesota Electronic Benefits Transfer (EBT) card.
  • Work Registration Notice
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    This notice explains the work requirements for Mandatory Work Registrants of the SNAP program and is given to new applicants and recipients at recertification.
  • What is Six-Month Reporting
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    Brochure describing six-month reporting and how it works.
  • Customer Satisfaction Survey
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    Survey of how well we provided service to you.
  • EBT Online Purchasing Program
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Combined Application Form Packet - Cash & SNAP (Spanish)10 documents

  • Wabasha County Cover Letter
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    Carta De Cubierta Del Condado De Wabasha
  • EBT Online Purchasing Program
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  • Combined Application Form
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    El Formulario de Solicitud Combinada se utiliza para recopilar la informacin necesaria para determinar la elegibilidad para todos los programas en efectivo del Departamento de Servicios Humanos de Minnesota y SNAP (asistencia alimentaria). Este formulario tambin se utiliza para la recertificacin de efectivo y programas SNAP.
  • Program Information for Cash, Food and Child Care Programs
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    Folleto que explica los diversos programas que administra el Departamento de Servicios Humanos, quin es elegible para esos programas y cmo solicitarlos.
  • Domestic Violence Information
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    Folleto que explica la violencia domstica y el abuso y cmo las vctimas pueden obtener una exencin de algunas de las reglas del DWP, MFIP y el Programa de Asistencia Nutricional Suplementaria (SNAP).
  • Family Violence Referral
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    Formulario de agencia utilizado para informar a las vctimas de abuso domstico cmo obtener ayuda.
  • Do You Have a Disability Brochure
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    Folleto que explica los derechos que tienen las personas con discapacidad y el tipo de ayuda disponible para ellos.
  • How to Use Your Minnesota EBT Card
    document seq 0.06
    Folleto que explica cmo usar la tarjeta de transferencia electrnica de beneficios de Minnesota (EBT).
  • Electronic Funds Transfer of Cash Benefits
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    Folleto que explica qu es la transferencia electrnica de fondos (EFT, por sus siglas en ingls) y un formulario de autorizacin para inscribirse en el depsito directo para programas en efectivo.
  • Food Support Reporting Responsibilities
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    Folleto que explica las responsabilidades de informes para el Programa de Asistencia Nutricional Suplementaria (SNAP).

General Assistance While in a Facility (Personal Needs)10 documents

  • Wabasha County Cover Letter
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    Wabasha County Cover Letter
  • EBT Online Purchasing Program
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  • Combined Application Form
    document seq 0.01
    The Combined Application Form is used to gather the information needed to determine eligibility for all Minnesota Department of Human Services cash programs and SNAP (food assistance). This form is also used for the recertification of cash and SNAP programs.
  • Programs Information for Cash, Food and Child Care Programs
    document seq 0.02
    Brochure about cash, food and daycare programs available.
  • Domestice Violence Information
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    Brochure about assistance with documestic violence.
  • Do You Have A Disability?
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    Brochure explaining the rights that people with disabilities have and the kind of help that is available to them.
  • SSI Interim Assistance Authorization
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    This is an agreement the client signs promising to repay funds received from state or county funded programs while their SSI application is being processed.
  • Interim Assistance Agreement
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    This is an agreement the client signs promising to repay funds received from state or county funded programs while their application is being processed for other specified benefit programs (non-SSI).
  • Electronic Funds Transfer for Cash Programs
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    Brochure explaining what Electronic Funds Transfer (EFT) is and an authorization form to sign up for direct deposit for cash programs.
  • Customer Satisfaction Survey
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    Survey of how well we provided service to you.

Long-Term Care Application8 documents

  • HCAPP for Payment of LTC Services
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  • MA Information for LTC and EW Brochure
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  • EW What You Need to Know Brochure
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  • Authorization to Obtain Information from the AVS System
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  • Customer Satisfaction Survey
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  • Verification Request Letter
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  • County MA and Estate Claim Brochure
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  • County Upon Death Signature Sheet
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Managed Care Under 659 documents

  • Contact Sheet
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  • FAQ
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  • Managed Care Guide to Health Plan Enrollment
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  • Pre-Enrollment Questionnaire
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  • Notice of Privacy Practices for All Health Care Programs
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  • Health Care Access Plan
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  • Customer Satisfaction Survey
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  • Medical Mileage Reimbursement Form
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  • Volunteer Drive Non-Disclosure Statement
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Managed Care Over 6510 documents

  • Contact Sheet
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  • FAQ
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  • Managed Care Guide to Health Plan Enrollment for Seniors
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  • Pre-Enrollment Questionnaire
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  • Notice of Privacy Practices for All Health Care Programs
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  • Rights and Responsibilities
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  • Health Care Access Plan
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  • Medical Mileage Reimbursement Form
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  • Customer Satisfaction Survey
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  • Volunteer Drive Non-Disclosure Statement
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MAXIS to METS Migration3 documents

  • Important Information - Health Care Coverage Options
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  • MNSure Application for Health Coverage and Help Paying Costs
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  • Customer Satisfaction Survey
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MCO Excluded DISA10 documents

  • MHCP Summary of Coverage, Cost Sharing, and Limits
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  • Health Care Access Plan
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  • Medical Mileage Reimbursement Form
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  • Notice of Privacy Practices for All Health Care Programs
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  • SNBC Health Plan Coverage
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  • SNBC Guide to Enrollment
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  • Managed Care for Persons with Disabilities Grid (Condensed)
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  • Helpful Resources
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  • Customer Satisfaction Survey
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  • Volunteer Drive Non-Disclosure Statement
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MCO Excluded - No DISA/Transer7 documents

  • MHCP Summary of Coverage, Cost Sharing, and Limits
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  • Health Care Access Plan
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  • Medical Mileage Reimbursement Form
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  • Notice of Privacy Practices for All Health Care Programs
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  • Helpful Resources
    document seq 0.00
  • Customer Satisfaction Survey
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  • Volunteer Drive Non-Disclosure Statement
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MEC2 PRO Provider Packet8 documents

  • User Agreement for MEC2 PRO Electronic Billing
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  • Direct Deposit for MN Child Care Assistance Prrograms
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  • Customer Satisfaction Survey
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  • Temorary Password Notification
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  • MEC2 PRO Provider Manual
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  • MEC2 PRO FAQs
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  • MEC2 Welcome to MEC2 PRO (email)
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  • MEC2 Welcome to MEC2 PRO (mail)
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MFIP3 documents

  • Reporting Responsibilities for MFIP Households
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    Brochure explaining the basic reporting requirements and budgeting process for the Minnesota Family Investment Program (MFIP).
  • Family Violence Referral
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    Agency form used to inform victims of domestic abuse how to get help.
  • Electronic Funds Transfer for Cash Programs
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    Brochure explaining what Electronic Funds Transfer (EFT) is and an authorization form to sign up for direct deposit for cash programs.

MFIP Application Non-Parental Caregiver Supplemental3 documents

  • MFIP Child Only Assistance
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    Brochure answering frequently asked questions relatives have about the Minnesota Family Investment Program (MFIP).
  • Electronic Funds Transfer for Cash Programs
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    Brochure explaining what Electronic Funds Transfer (EFT) is and an authorization form to sign up for direct deposit for cash programs.
  • Customer Satisfaction Survey
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    Survey of how well we provided service to you.

MFIP Application (Under 20) Supplemental5 documents

  • Notice of Requirement to Attend School
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    Notice to MFIP clients informing them of the requirement to attend school, exceptions to the requirement and what will happen if they do not attend school.
  • Graduate to Independence - MFIP Teen Parent Informational Brochure
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    Brochure explaining the educations requirements for MFIP teen parents.
  • MFIP for Minor Caregivers
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    Brochure explaining what constitutes a minor caregiver, requirements for minor caregivers to receive MFIP and exceptions to those requirements.
  • Family Violence Referral
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    Agency form used to inform victims of domestic abuse how to get help.
  • Electronic Funds Transfer for Cash Programs
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    Brochure explaining what Electronic Funds Transfer (EFT) is and an authorization form to sign up for direct deposit for cash programs.

MFIP/DWP Packet8 documents

  • Minnesota Family Investment Program
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  • Minnesota's Diversionary Work Program
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  • Reporting Responsibilities for MFIP Households
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  • Electronic Funds Transfer
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  • Family Violence Referral
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  • Notice of Privacy Practices
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  • Customer Satisfaction Survey
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  • Community Resource Booklet
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MFIP Recertification (Under 20) Supplemental4 documents

  • MFIP for Minor Caregivers
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    Brochure explaining what constitutes a minor caregiver, requirements for minor caregivers to receive MFIP and exceptions to those requirements.
  • Family Violence Referral
    document seq 0.00
    Agency form used to inform victims of domestic abuse how to get help.
  • Electronic Funds Transfer for Cash Programs
    document seq 0.00
    Brochure explaining what Electronic Funds Transfer (EFT) is and an authorization form to sign up for direct deposit for cash programs.
  • Customer Satisfaction Survey
    document seq 0.00
    Survey of how well we provided service to you.

SNAP Application & Recertification12 documents

  • Wabasha County Cover Letter
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  • Community Resource Booklet
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    Community Resource Booklet
  • EBT Online Purchasing Program
    document seq 0.00
  • Program Information for Cash, Food, Child Care, and Health Care Programs
    document seq 1.00
    Brochure explaining the various programs the Department of Human Services manages, who is eligible for those programs and how to apply for them.
  • Domestic Violence Information
    document seq 2.00
    Brochure explaining domestic violence and abuse and how victims can get a waiver from some of the DWP, MFIP and Supplemental Nutrition Assistance Program (SNAP) rules.
  • Do You Have a Disability Brochure
    document seq 3.00
    Brochure explaining the rights that people with disabilities have and the kind of help that is available to them.
  • Food Support Reporting Responsibilities
    document seq 4.00
    Brochure explaining the reporting responsibilities for the Supplemental Nutrition Assistance Program (SNAP).
  • Facts on Voluntarily Quitting Your Job
    document seq 5.00
    Fact sheet informing clients of the Supplemental Nutrition Assistance Program (SNAP) penalties for voluntarily quitting a job without good reasons.
  • How to Use Your Minnesota EBT Card
    document seq 6.00
    Booklet explaining how to use the Minnesota Electronic Benefits Transfer (EBT) card.
  • Work Registration Notice
    document seq 7.00
    This notice explains the work requirements for Mandatory Work Registrants of the SNAP program and is given to new applicants and recipients at recertification.
  • What is Six-Month Reporting
    document seq 8.00
    Brochure describing six-month reporting and how it works.
  • Customer Satisfaction Survey
    document seq 9.00
    Survey of how well we provided service to you.