Forms for human services benefits

Below is a list of frequently requested Human services forms. Click on the form to complete and print.

Learn how to submit documents.

• Absent parent statement
• Application for payment of long-term care services
• Authorization to obtain or release information/records
• Change report form
• Child care assistance program (CCAP) Change Report
• Combined annual renewal for certain populations
• Combined application form (or complete via MNbenefits.org)
• Combined application – addendum (DHS)
• Combined six-month report
• Employment verification
• Financial aid verification
• Gift or loan statement
• Household report form (HRF)
• Household update form (or complete via MNbenefits.org)
• Interim assistance authorization (submit online)
• Interim assistance authorization – SSI (submit online)
• Minnesota health care programs (MHCP) – Application for certain populations
• Minnesota health care programs (MHCP) – Renewal
• Minnesota health care programs (MHCP) – Renewal for families, children and adults
• Minnesota health care programs (MHCP) – Renewal for people receiving long-term care services
• MNsure – Application for health coverage and help paying costs
• Request for medical opinion
• School verification
• Self employment report
• Shelter verification form (complete and print)
• Shelter verification online form (submit online)
• SNAP volunteer and unpaid work experience hours log (PDF, 1MB)
• Special diet instruction request
• Statement of assets
• Veterans Services: online intake form
• Work activity verification log

If you are not able to find the form you are looking for, search for additional forms below:

Searchable document library (eDocs) / Minnesota Department of Human Services (mn.gov)