MN DHS-3163B 2019-2025 free printable template
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Clear FormDHS3163BENG1019Referral to support and collections
Purpose of formFOR OFFICE USE ONLYThe child support agency will use the information you give to help collect support.CASE NUMBERHow to
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How to fill out dhs-3163b-eng referral to support
How to fill out MN DHS-3163B
01
Begin by downloading the MN DHS-3163B form from the official Minnesota Department of Human Services website.
02
Fill in your personal information at the top of the form, including your name, address, and contact details.
03
Indicate the type of service or assistance you are applying for, if applicable.
04
Provide any necessary identification numbers, such as Social Security Number or Client ID.
05
Complete each section of the form according to the instructions, including details about your household and income.
06
Attach any required documentation, such as proof of income or residency.
07
Review your completed form for accuracy and completeness.
08
Sign and date the form at the bottom before submitting it.
09
Submit the form via mail or in-person to the designated office as indicated in the instructions.
Who needs MN DHS-3163B?
01
Individuals or families who are applying for certain public assistance programs in Minnesota.
02
Anyone seeking to obtain or renew benefits related to healthcare, food assistance, or other services provided by the Minnesota Department of Human Services.
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What is MN DHS-3163B?
MN DHS-3163B is a state form used in Minnesota for reporting certain information related to healthcare and human services.
Who is required to file MN DHS-3163B?
Entities or individuals who provide healthcare services or are involved in human services programs typically are required to file MN DHS-3163B.
How to fill out MN DHS-3163B?
To fill out MN DHS-3163B, ensure you have all required information at hand, clearly follow the instructions provided on the form, and provide accurate details about the services rendered.
What is the purpose of MN DHS-3163B?
The purpose of MN DHS-3163B is to collect data that helps the Minnesota Department of Human Services monitor and evaluate the provision of healthcare and human services.
What information must be reported on MN DHS-3163B?
Information that must be reported on MN DHS-3163B typically includes details about the services provided, client demographics, and other relevant data as specified in the form's instructions.
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