dhs 6696
Printable application forms for health care programs
A tax credit and payment assistance to lower your cost for coverage. This form is also available in these languages: Hmong - MNsure application DHS-6696 (PDF)
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24-port VDSL POTS Splitter
The DHS-24SP provides signal splitting between VDSL and POTS for 24 VDSL ports. This device can be used with VDSL switches such as the DHS-3212/DHS-3224.
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MinnesotaCare available for DACA - A-mail
Jan 20, 2017 DACA grantees who want to apply for MinnesotaCare must use the DHS-6696, Application for Health Coverage and Help Paying Costs. Forward
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