External Provider Resources - Contacts & Forms

Provider Contacts

1. AHRMS Providers-DHS 
2. Domestic Violence Resources
3. RC Employment Services Providers 6/2024
4. FAS-ES Liaison Contacts 6/2024
5. Food Shelves in Ramsey County
6. Homeless Shelters - 2/18

CLUES Partners for Equity Program Information

1. CLUES Trainings - Flyers 2024
2. CLUES PE 2023 Programs 
3. CLUES PE flyer 9/20/23
4. CLUES PE Process 9/20/23.pdf
5. CLUES PE Referral Form 9/20/23
6. WF1 User Guide - CLUES Partners for Equity 8/24/20

Documents & Forms link:  Lifelong Learning Initiative Tools & Process - Ramsey County

DWP/MFIP Forms - Ramsey County

1. 48+Interview - 4/7/2017
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 2021
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 - 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)

SNAP E&T Forms - DHS

1. DHS SNAP ET website
2. Activity Log DHS-6935
3. Domestic Violence Brochure DHS-3477
4. Employment Plan DHS-6020
5. Employment Verification Form DHS-2146
6. Medical Opinion Form DHS-2114
7. Notice of Privacy Practice DHS-3979
8. Rights and Responsibilities DHS-3172
9. School Verification Form DHS-2883
10. SNAP Brochure DHS-2814
11. Status Update Form DHS-3165A