Clear FormDHS7122ENGProfessional Statement of Need APPLICANT 'S LEGAL NAMEAPPLICANT 'S CHOSEN NAMED ATE OF BIRTH(For Office Use Only) MAXIS CASE NUMBERQualified Professionals (as defined in Section.

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

This guide provides a step-by-step approach to completing the MN DHS-7122-ENG form, which is essential for individuals seeking Medical Assistance Housing Stabilization Services or Minnesota Housing Support. The following instructions will help you navigate the online form with clarity and confidence.

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

  1. Click the ‘Get Form’ button to obtain the MN DHS-7122-ENG form and open it in your preferred online editor.
  2. Begin by filling out the applicant's legal name and chosen name where indicated at the top of the form. Ensure that this information matches official identification documents.
  3. Enter the date of birth of the applicant in the designated field. This information is crucial for eligibility verification.
  4. For office use only, enter the MAXIS case number if applicable. This number helps maintain your application in the system.
  5. Essentially, in Section 1 (Housing Situation), select all applicable options regarding the current housing status of the applicant. This section is mandatory for those applying for Medical Assistance Housing Stabilization Services.
  6. In Section 2 (Disabling Condition), provide details about the disabling condition as outlined. Ensure it is completed and signed by the appropriate Qualified Professional to validate the information.
  7. If applicable, complete Section 3 (Medical Assistance Housing Stabilization Services) by identifying specific areas where the applicant requires support to find or maintain stable housing. This section also requires a Qualified Professional's signature.
  8. For Minnesota Housing Support, populate Section 4 by indicating the necessary supports to maintain housing. You must select at least two options from the listed supports provided here.
  9. If the applicant is exiting a residential treatment program, complete Section 5. Ensure that all required signatures are collected from relevant professionals.
  10. Finally, review all information entered for accuracy and completeness. Make any necessary adjustments before saving changes, downloading, printing, or sharing the form as required.

Complete the MN DHS-7122-ENG online today to ensure your access to vital housing support services.

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How do I contact Minnesota Department of Human Services?

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.

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.

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.

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.

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