Licensing forms

This is an online listing of forms maintained by the Department of Human Services.

Forms listed are in the portable document format (PDF). For more information, see the DHS PDF page. scription: pdf_icon_sm

Forms for adult day centers

Forms for adult foster care

Forms for background studies

Forms for child care centers

  • Forms for child foster care

    Forms for family child care

    SUDDEN UNEXPECTED INFANT DEATH (SUID) VIDEO TRAINING FOR FAMILY CHILD CARE

    SUID Requirements and Video Links

    2014 TRAINING DOCUMENTS

    OTHER DOCUMENTS

  • Forms for developmental disabilities programs

    IMPORTANT NOTICE REGARDING DD SERVICES LICENSED UNDER 245B

    The terminology used to describe people with developmental disabilities has changed over time.  While DHS supports the use of “people first” language within its documents, certain outdated terms may be found within historical and official documents, such as statutes and reports.

    Forms

  • • Death or Serious Injury Form
  • • Death or Serious Injury Report FAX Cover Sheet Please note a second fax number is available for the Ombudsman’s Office, 651-296-1021. It is recommended that you use this number when faxing reports to the Ombudsman. This form will be updated when the 245D HCBS Standards become effective Jan. 1, 2014.
  • • Letter of Acknowledgement for Residential Habilitation Services Providers
  • • Variance request
  • Self-Monitoring Checklists for DD Services

    General Information

    Psychotropic Medication Use and Monitoring Forms

    Policies

    Forms for Family Systems programs

  • Forms for Home and Community-Based Services (HCBS)

    Forms for mental health and chemical health programs

    All Programs

    License Application Forms

    Children’s Residential Treatment Facilities

    Independent Living Assistance for Youth

    Intensive Residential Treatment Services

    [Includes Crisis Stabilization (CS) and Eating Disorders (ED) Certification]

    Minnesota Sex Offender Programs

    Mental Health Clinics and Centers

    Chemical Dependency Treatment Programs

    Rule 31 – Forms used only by Programs serving Clients with their Children

    Detoxification Services

    Forms for private child placement agencies

  • For more information about licensing forms, call (651) 431-6500; or fax to (651) 431-7643. TTY/TDD users can call the Minnesota Relay at 711 or (800) 627-3529. For the Speech-to-Speech Relay, call (877) 627-3848.


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