Frequently used forms and resources

Page updated: 4/8/26

This page lists DHS forms, resource pages and additional resources referenced throughout the DD Screening Document Codebook. Use the DHS eDocs searchable document library to search for and download forms, applications and other documents in other languages.

Forms

Case Manager’s Guide to Determining ICF/DD Level of Care, DHS-4147A (PDF)
DD Screening Document, DHS-3067 (PDF)
Nursing Facility Level of Care – Preadmission Screening and Community Assessment for People Younger than 21 Years Old, DHS-3361 (PDF)
OBRA Level I Criteria – Screening for Developmental Disabilities or Mental Illness, DHS-3426 (PDF)
OBRA Level II evaluative report for people with developmental disabilities, DHS-4248 (PDF)
OBRA Level II evaluative report signature sheet, DHS-4248B (PDF)
Related Conditions Checklist/Instructions, DHS-3848 (PDF) and Instructions, DHS-3848 (PDF)

Refer to CBSM – Forms for additional forms.

Resource pages

Resource: Behavioral dysregulation
Challenging behavior rating scale (PDF)
Checklist for completing the DD screening document (PDF)
Current and planned services definitions (PDF)
DD screening document edits (PDF)
DT&H staffing ratios (PDF)
Independent living skills definitions (PDF)
Minnesota county, tribal nation and managed care organization codes
Special support services definitions (PDF)