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Clear Form×DHS3050ENG* DHS3050ENGMinnesota Health Care ProgramsLongTerm Care/County Communication Format: CM/CD/BY Case number: XXXXXXXFacility: Bethany Care CenterWorker name: IMA WorkerFacility
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The dhs-3050-eng is a form used to report information related to immigration status and benefits eligibility.
Individuals who are seeking or receiving benefits from the Department of Homeland Security may be required to file dhs-3050-eng.
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The purpose of dhs-3050-eng is to ensure that individuals are eligible for benefits and to verify their immigration status.
Information such as name, date of birth, immigration status, and benefits received must be reported on dhs-3050-eng.
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