External Provider Resources - Contacts & Forms

Provider Contacts

1. AHRMS Providers-DHS 
2. Domestic Violence Resources
3. Food Shelves in Ramsey County 
4. FAS-ES Liaison Contacts 9.2024
5. MFIP ES providers 12.2024

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

LLI - Ramsey County Documents & Forms

1.  Lifelong Learning Initiative Tools & Process 

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)