Below are links to commonly used Hennepin County Forms and publications.
**This site is not intended to provide eligibility or funding information. These are only links to the applicable county which is published as public information on the Minnesota DHS Website.
Click on any Green Button to be linked to the following information or forms.
Change Report Form
Shelter Verification Form
Household Report Form
Interim Assistance Form
Employment Verification Form
Voluntary Vendor Payment Form
Professional Statement of Need Form
Habitability Inspection Form
For any of the below forms, click the green button at the bottom of this column
* Child Care Assistance Program Application (PDF)
• Child support application information
• Combined Application Form (PDF) – cash assistance or food benefits
• Diversionary Work Program application information
• HIV/AIDS Programs Application (PDF)
• Human services provider license application forms
• Long-Term Care and Waiver Services Application (PDF)
• Medical Assistance for Breast or Cervical Cancer application (PDF)
• Minnesota Family Investment Program application information
• Minnesota Family Planning Program Application (PDF)
• Minnesota Health Care Programs application information
• Minnesota Health Care Programs provider enrollment application information
• Supplemental Nutrition Assistance Program (SNAP) application information (food benefits)
• Telephone Equipment Distribution Program Application (PDF)
Hennepin County Economic Assistance:
612-596-1300
Emergency Assistance Link
Hennepin County Shelter Link
Hennepin County Burial Assistance Information
Call: 612-348-7984