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In Section 2) use this form to confirm that a person meets certain criteria for one or both of the following: Medical Assistance Housing Stabilization Services Minnesota Housing Support Program After completing this form, please return to the person or their authorized representative. This request does not represent an offer of payment on the part of the state, county, or tribe. Do you authorize the Qualified Professional to release your information? (read and sign below) I give permissi.

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How to fill out the MN DHS-7122-ENG online

Filling out the MN DHS-7122-ENG form is an essential step in accessing housing support services. This guide offers a clear and structured approach to completing the form online, ensuring that all necessary information is provided accurately.

Follow the steps to complete the MN DHS-7122-ENG online

  1. Click the ‘Get Form’ button to access the form and open it in the online editor.
  2. Begin by entering the applicant's name in the designated field, ensuring accurate spelling as this is crucial for identification.
  3. Provide the date of birth of the applicant in the format specified on the form.
  4. If available, enter the housing provider's name in the appropriate section. If not applicable, you may leave this section blank.
  5. Input the MAXIS case number if you have it available; this helps track the applicant’s status.
  6. In Section 1, select all applicable options that describe the applicant's housing situation. You may choose multiple options if relevant.
  7. In Section 2, mark the relevant disabling condition, and provide the name and signature of a qualified professional who has assessed the applicant.
  8. Complete Section 3 by having a qualified professional identify the specific areas in which the applicant needs support to maintain stable housing.
  9. In Section 4, indicate the types of Minnesota Housing Support Supplemental Services needed, with assistance from a qualified professional or county designee, if applicable.
  10. For Section 5, if completing for a transition from residential treatment, ensure the behavioral health treatment staff fills out the necessary information about the treatment program and discharge date.
  11. Once all sections are filled out, review the information for accuracy. Save your changes periodically.
  12. After completing the form, download or print a copy for your records. Finally, submit the form online or share it with the appropriate party as instructed.

Complete your MN DHS-7122-ENG form online to ensure access to essential housing support services.

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Service Details Provides long-term support programs that help people with disabilities as they live in the community. Disability Hub MN is a free statewide service that helps people find options to live independently. Visit the website, or call (866) 333-2466 (8:30am - 5:00pm, Monday - Friday) for more information.

Bridges Program Program participants contribute between 30-40% of their income toward rent. The remaining portion of their rent is paid by the CDA. Priority is given to people living in an institution, segregated setting, or under corrections supervision who will be homeless upon exit.

For those eligible, Housing Stabilization Services (HSS) is a Minnesota Medical Assistance benefit to help people with disabilities (including mental illness and substance use disorder) and seniors find and keep housing.

Housing Stabilization Services is a new Minnesota Medical Assistance benefit to help people with disabilities, including mental illness and substance use disorder, and seniors find and keep housing. Sign up for Housing Stabilization Services updates.

Housing Stabilization Services is a new Minnesota Medical Assistance benefit to help people with disabilities, including mental illness and substance use disorder, and seniors find and keep housing. Sign up for Housing Stabilization Services updates.

The Department of Human Services provides economic assistance for qualifying families. It helps people go to or look for work, attend school, have nutritious food, and gain independence.

Heading Home Dakota Mission and Vision We will prevent and end homelessness for every man, woman, and child in Dakota County within ten years, partnering with residents and private and public stakeholders.

The Housing Resource Line (651-554-5751) is for people experiencing homelessness or at imminent risk of homelessness. If your client does not fit this description, but is still in need of services, please call Dakota County's Adult Intake at 651-554-6000.

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