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Income
Maintenance/Financial Assistance
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Social Services |
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New HEALTH CARE ONLY Applicants
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Application for Social Services
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* Forms to be completed by new applicants
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Eligibility and Fee Policy
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Program Information for Health
Care |
Program Information for Adult
Rehabilitative Mental Health Services (ARMHS) |
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Program Information for Long Term
Care & Waiver Services |
Program Information for
Alternative Care (AC) and Elderly Waiver (EW) |
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Health Care Income & Assets
Guidelines |
(AC & EW - Waiver program for seniors that helps pay
for services so they can stay in their homes)
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MinnesotaCare Income Guidelines |
Program Information for Community
Alternative Care (CAC) Waiver |
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*Application
for Medical Assistance & Minnesota Care
(OR) |
(CAC - Home and Community Based Services Waiver for
children and adults who are chronically ill or medically
fragile and that offers a menu of services to help
people live in their community as fully, productively
and independently as possible.) |
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Application for Long Term Care &
Waiver Services |
Program Information for Community
Alternatives for Disabled Individuals (CADI) |
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Health Care Access Notice |
(CADI - A Home and Community Based Services Waiver
for children and adults who require the level of care
provided in a nursing home and that offers a menu of
services to help people live in their community as
fully, productively and independently as possible) |
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Important Fraud Notice |
Program Information for the
Consumer Support Grant (CSG) |
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Information of Other Parent -
Child Support |
Program Information for
Developmentally Disabled (DD) Waiver |
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*Request
for Proof of Citizenship |
(DD - A Home and Community Based Services Waiver for
children and adults ho have mental retardation or a
related condition and that offers a menu of services to
help people live in their community as fully,
productively and independently as possible.) |
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*Request
to Apply for Health Care |
Program Information for the Family
Support Grant (FSG) |
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Program Information for Traumatic
Brain Injury (TBI) Waiver |
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(TBI - A Home and Community Based Services Waiver for
children and adults who have a diagnosis of brain injury
and require the level of care provided in a specialized
nursing home or a neurobehavioral hospital and that
offers a menu of services to help people live in their
community as fully, productively and independently as
possible.) |
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Release of Information |
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New Applicants for Cash, Food, & Health Care |
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(if only applying for Health Care, see above) |
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* Forms to be completed by new applicants |
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additional forms may be requested by your worker |
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Program Information for Cash,
Food, & Health Care |
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*Application
for Cash Assistance, Food Support & Health Care (CAF) |
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CAF Important Information |
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Disability Information Brochure |
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Domestic Violence Information
Brochure |
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Facts on Voluntarily Quitting Your
Job |
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Family Violence Referral |
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Health Care Access Notice |
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Important Fraud Notice |
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Important Notice |
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Info on Other Parent - Child
Support (*complete if absent parent) |
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Info to Apply for Assistance |
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Notice about IEVS |
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Notice of Privacy Practices |
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Verification Request A |
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Verification Request B |
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**In accordance with Federal law and U.S. Department of
Agriculture policy, this institution is prohibited from
discriminating on the basis of race, color, national
origin, sex, age, religion, political beliefs, or
disability. To file a complaint of discrimination,
write USDA, Director, Office of Civil Rights, 1400
Independence Avenue SW, Washington, D.C. 20250-9410 or
call (866) 632-9992 (voice), (800) 877-8339 (TTY) or
(866) 377-8642 (TTY). USDA is an equal opportunity
provider and employer. |
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Other Forms for Financial Assistance |
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Addendum - ENGLISH |
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Addendum - SPANISH |
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Asset Assessment for Medical
Assistance |
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Change Report Form - ENGLISH |
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Change Report Form - SPANISH |
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Claim Form for Medical Trips |
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Combined 6 Month Reporting Form |
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Household Report Form |
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Pregnancy Verification Form |
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Shelter Form |
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