External Provider Resources - Contacts & Forms

Provider Contacts

1. AHRMS Providers-DHS 
2. Domestic Violence Resources
3. Employment Services Division Directory Feb 2023
4. RC Employment Services Providers 5.2023
5. FAS-ES Liaison Contacts 11.2022
6. Food Shelves in Ramsey County - 6/1/2018
7. Homeless Shelters - Feb. 2018
8. Career Pathways Training Opportunities - 3/21/2019
9. St Paul College-Power of You Program-HS graduates

CLUES Partners for Equity Program Information

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

Forms/Documents 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. 2018 Invoice and Budget Modification Form - 5/9/2018
4. Authorization to Communicate Through Email and Texting
5. Case Transfer Form revised 3/18/2020
6. ChildCare Transmittal
7. DHS Systems Request Access Form2-7-23
8. Extension Decision Form 9 2021
9. Extension Quick Reference for LF and Case Note 12/2019
10. Face to Face Extension Checklist
11. FSS Eligibility Screening Form
12. MFIP Education and Training Guide
13. Request for Medical Information
14. Request for Medical Opinion - Family Member
15. Request for Medical Opinion - Participant
16. Request for Medical Opinion - Serious and Persistent Mental Illness
17. Request for Medical Opinion - Severe Emotional Disturbance
18. Request for Medical Opinion - Temporarily Unemployable Participant
19. Sample Letter - Child Under Age One
20. WF1 User Access Request Form-MFIP DWP SNAP - fillable 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
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 - Ramsey County

1. CBO Referral Letter - 11/1/2017
2. Participants County Agency SNAP ET Service Agreement rev - 10/20/2017
3. Pre-Enrollment Form 2018 
4. RC Reverse Referral Chart 9/12/2017

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