Clear FormDHS7122ENGProfessional Statement of Need APPLICANT'S NAMEAPPLICANT'S LEGAL NAME (IF DIFFERENT)DATE 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
Completing the MN DHS-7122-ENG form online is an essential step for individuals seeking assistance with housing support. This guide provides clear, step-by-step instructions for filling out each section of the form to ensure you submit accurate information.
Follow the steps to successfully complete the MN DHS-7122-ENG form online.
- Press the ‘Get Form’ button to obtain the MN DHS-7122-ENG form and open it in your preferred online editor.
- Begin filling out Section 1: Housing Situation. Indicate your current housing status by selecting one or more options provided. This section is mandatory for Medical Assistance Housing Stabilization Services applicants.
- Proceed to Section 2: Disabling Condition. Ensure this section is completed by a qualified professional. Select the applicable disabling condition and provide the required information about the qualified professional.
- If you are applying for Medical Assistance Housing Stabilization Services, fill out Section 3: Medical Assistance Housing Stabilization Services. Indicate the areas where support is needed to find or maintain stable housing.
- For Minnesota Housing Support, complete Section 4: Minnesota Housing Support Supplemental Services. Indicate two or more supports that are needed to access or maintain housing.
- If applicable, complete Section 5: Transition from Residential Treatment to Minnesota Housing Support Program. This section must be filled by residential treatment staff for those exiting a behavioral health treatment program.
- Once all sections are completed, review your information carefully. You will need to electronically sign the form by checking 'I agree' and typing your name in the signature field.
- After reviewing and signing, you can save changes, download, print, or share the completed form as needed.
Complete your MN DHS-7122-ENG form online today to access the assistance you need.
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Get answers to your most pressing questions about US Legal Forms API.
What is housing stabilization services in Dakota County?
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.
What is MN Department of Human Services?
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.
What is heading home Dakota County?
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.
What is Minnesota housing Stabilization Services?
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.
What is the housing resource line in Dakota County?
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.
What is housing stabilization services in MN?
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.
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.
What is the bridges program in Dakota County?
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.
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