External Provider Resources - Contacts & Forms

Provider Contacts

  1. AHRMS Providers-DHS 
  2. Domestic Violence Resources
  3. FAS-ES Liaison Contacts 9.2024
  4. RC Employment Services Providers 6/2024
  5. Food Shelves in Ramsey County

CLUES Partners for Equity Program Information

  1. CLUES PE Process 10/2024
  2. CLUES PE Referral Form 9/2024
  3. CLUES PE Activities
  4. CLUES Trainings
  5. WF1 User Guide - CLUES Partners for Equity

Documents & Forms

 Lifelong Learning Initiative Tools & Process - Ramsey County

DWP/MFIP Forms - Ramsey County

  1. 48+Interview - 4/7/2017 (optional form)
  2. 90 Day ES Training Guide Packet - 7/28/2017
  3. Invoice and Budget Modification Form
  4. Authorization to Communicate Through Email and Texting
  5. Case Transfer Form revised 3/18/2020
  6. Child Care Transmittal
  7. Child under 12 month exemption sample letter
  8. DHS Systems Request Access Form 7/30/24
  9. Education Training Guide 5/2024 ; Education Training Counselor Checklist. 5/2024
  10. Extension Decision Form 9/2024
  11. Extension Quick Reference for LF and Case Note 12/2019
  12. Face to Face Extension Checklist
  13. FSS Eligibility Screening Form 8/2024
  14. Request for Medical Information
  15. Request for Medical Opinion - Family Member
  16. Request for Medical Opinion - Participant
  17. Request for Medical Opinion - Serious and Persistent Mental Illness
  18. Request for Medical Opinion - Severe Emotional Disturbance
  19. Request for Medical Opinion - Temporarily Unemployable Participant
  20. WF1 User Access Request Form - MFIP DWP 8/29/23

DWP/MFIP Forms - MN DHS

  1. Authorization for Release of Employment Information (2146)
  2. Brief Screening Tool for Special Learning Needs (3504)
  3. DWP/MFIP Observation Checklist (3483)
  4. Employability Measure; EM User Guide
  5. MFIP Education Activity Log (DHS-4209N)
  6. Employment Services Responsibilities, Rights and Consent (3172)
  7. Family Stabilization Sanction Checklist - June 2016 (docx)
  8. Family Stabilization Services Sample Medical Cover Letter (5285)
  9. Family Violence Referral (3323)
  10. Household Report(2120) updated - Sept. 2017
  11. MFIP/DWP Employment Plan Case Information (4209)
  12. MFIP/DWP Employment Plan - Child Care or Transportation (4209H)
  13. MFIP/DWP Employment Plan - County/State Social Services (4209M)
  14. MFIP/DWP Employment Plan - Education (4209D)
  15. MFIP/DWP Employment Plan - Employment (4209A)
  16. MFIP/DWP Employment Plan - Family Safety (4209E)
  17. MFIP/DWP Employment Plan - Health (4209I)
  18. MFIP/DWP Employment Plan - Housing (4209J)
  19. MFIP/DWP Employment Plan - Job Search Requirements (4209B)
  20. MFIP/DWP Employment Plan - Legal Issues (4209L)
  21. MFIP/DWP Employment Plan - Personal/Family Activity (4209K)
  22. MFIP/DWP Employment Plan - Unpaid Work Activities (4209C)
  23. MFIP/DWP ES Weekly Job Search Activity Log (5784)
  24. MFIP ES Authorization to Release of Information (4093)
  25. MFIP Notice of Intent to Sanction (3175)
  26. MFIP Self-Screen (3482)
  27. MFIP Self-Screen Scoring Form (3482A)
  28. Minnesota Child Care Assistance Program Application (3550)
  29. Notice of Privacy Practices (3979)
  30. Notice of Requirement to Attend MFIP Overview (2929)
  31. Request for Verification of School Attendance/Progress (2883)