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Department of Human Services

MNDHS Home Page
DHS Electronic Forms

DHS 3131 Notice of IPV - Waiver (Fillable)
DHS 3131A Notice of IPV (CCAP) - Waiver (Fillable)
DHS 3132 - Request for ADH (Fillable)
DHS 3132 Request for Provider ADH (CCAP) Fillable
DHS 3134 - Notice of Disqualification for IPV (Fillable)
DHS 3134 - Notice of Disqual for IPV (CCAP) Fillable
DHS 3335a - Fraud Prevention Investigation Referral
DHS 3335b - Summary of Investigation
DHS 3385 - Permission to Search (FPI)
DHS 3386 - Consent for Release of Information
DHS 3436 - Request for Investigative Subpoena
DHS 3429 - Disqualification Consent Agreement (CHANGE
FROM MS FORM)
DHS 3429A - Disqualfication Consent Agreement (CCAP)
DHS 4300A - Disqualifiction Consent Agreement (CCAP)
DHS 4300 - Request for Worker' Compensation Info
DHS 4930A - Notice of Privacy Practices - Inv

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