MN HE-01387 2011 free printable template
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Minnesota Department of Health Well Management Section P.O. Box 64975 St. Paul, Minnesota 55164-0975 651-201-4587 or 800-383-9808 www.health.state.mn.us/divs/eh/wells WELL DISCLOSURE STATEMENT Prior
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How to fill out MN HE-01387
01
Begin by downloading the MN HE-01387 form from the official website.
02
Provide your personal information at the top of the form, including your full name, address, and contact details.
03
Fill out the section related to your income details, ensuring to include all sources of income.
04
Complete the expenses section by listing all relevant monthly expenses accurately.
05
Review the eligibility criteria and check the corresponding boxes to certify your status.
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Sign and date the form at the designated area to validate your application.
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Make a copy of the completed form for your records before submitting.
Who needs MN HE-01387?
01
Individuals or families seeking assistance with healthcare costs may need MN HE-01387.
02
People applying for financial aid or subsidies under state healthcare programs should fill out this form.
03
Individuals who require proof of income and expenses for healthcare-related applications need this form.
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People Also Ask about
What is the phone number for the Minnesota Department of Health unique well?
Please contact the Well Management Section at 651-201-4600 or 800-383-9808, or health.minnesotawellindex@state.mn.us for the following: MWI application is not working.
How deep is a well in Minnesota?
Wells in Minnesota range in depth from 15 feet to over 1,000 feet. Wells that are drilled very near each other often have similar depths. However, the depth of wells in glacial deposits can vary greatly — even if they are located next door to each other.
How many wells are in Minnesota?
The County Well Index (or CWI) is a database that contains subsurface information for over 533,000 water wells drilled in Minnesota.
What is the statute 103I 235 in Minnesota?
When a home, farm, or other property is sold or transferred, Minnesota Statutes, section 103I. 235, requires that the seller of real estate must disclose the number and the status of all wells on the property and provide a sketch map showing the location of each well.
What is the statute of well disclosure in Minnesota?
What is well disclosure? Well disclosure is the process by which the seller of property provides information to the buyer and the state about the location and status of all wells on the property. This process is required by state law, a portion of the Ground Water Protection Act (Minnesota Statutes, section 103I. 235).
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What is MN HE-01387?
MN HE-01387 is a form used in Minnesota for health care providers to report certain financial and operational information to the state.
Who is required to file MN HE-01387?
Health care providers in Minnesota that meet specific criteria related to revenue or services are required to file MN HE-01387.
How to fill out MN HE-01387?
To fill out MN HE-01387, providers must provide detailed financial information, report on patient services, and complete any required sections accurately according to the instructions provided with the form.
What is the purpose of MN HE-01387?
The purpose of MN HE-01387 is to collect data that helps the state assess the financial health and operational efficiency of health care providers.
What information must be reported on MN HE-01387?
The information that must be reported on MN HE-01387 includes revenue statistics, types of services provided, patient demographic data, and operational expenses.
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