Get Mn Rule 25 Consolidated Fund Application 2011-2025

Completing the MN Rule 25 Consolidated Fund Application is an essential step for individuals seeking state-funded chemical dependency treatment. This guide offers a comprehensive, step-by-step approach to ensure you can fill out the application accurately and efficiently.

Follow the steps to complete your application online.

1. Press the ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill in the application date and expiration date as indicated. This helps to track the validity of your application.
3. Provide your full client information. Include your last name, first name, and middle name. Ensure that this is printed clearly.
4. Include your address and provide verification. You may submit a recent piece of mail with your name and address, lease copy, or a signed statement from the homeowner.
5. Enter your contact details, including home, work, and cell phone numbers. Provide your date of birth and social security number.
6. Indicate your gender, marital status, race, and whether you identify as having Hispanic ethnicity. If applicable, provide details regarding your veteran status.
7. In the family information section, state the total number of persons living in your household and list the members of your family unit along with their birthdates, genders, and relationships to you.
8. In the insurance information section, specify whether you are receiving Medical Assistance or Minnesota Care benefits. Provide details of any private health insurance you have, including the company name, policy number, and other necessary information.
9. Complete the income information sections. Indicate your employment status, average weekly income, and provide any required documentation like pay stubs or tax returns.
10. Answer the financial information questions regarding unearned income and child support. Provide necessary verification where applicable.
11. In the referral, legal, and social service information section, provide relevant details about your assessments, court orders, probation status, and other legal matters.
12. Fill out the chemical usage information, indicating if you are an IV drug user and the drugs or chemicals currently being used.
13. Review the declarations section. Provide your signature, printed name, and the date to attest that the information provided is accurate and complete.
14. Once you have completed the form and added all required verifications, save your changes. You can then download, print, or share the form as needed.

Get started on your application online today to access the support you need.