Forms

Public Assistance Forms

Release Forms:

AREP Authorization form for SNAP, CASH, Medical (DOC) - This form is used to designate an authorized representative of your choosing who can communicate with Economic Assistance.

DHS 2952 Authorization for Release of Information About Residence and Shelter Expenses - This form is used to allow a landlord or homeowner information about your shelter expense.

DHS 3549 General Consent/Authorization for Release of Information (PDF) - This form allows you to give Economic Assistance the authority to share specific information with another person or agency.

GEN 205 Emergency Programs Release Form - This form is used to allow Economic Assistance to contact landlords and utility companies in order to complete our Emergency Assistance or Emergency General Assistance application.

Verification Forms:

GEN 12 Employment Verification Stop Work - This form is used to provide information regarding a job that has ended.

GEN 12 Employment Verification Start Work - This form is used to provide information regarding a job that has started.

Probate Forms:

DHS 5893 Application for Certificate of Clearance for Medical Assistance Claim - Transfer on Death Deed (PDF) - This form is used to request a Certificate of Clearance when the property was transferred using a Transfer on Death Deed. Please seek professional legal advice if you are not sure this is the correct form for your situation.

DHS 6165A Application for Certificate of Clearance for Medical Assistance Claims - Decree of Descent (PDF) - This form is used to request a Certificate of Clearnace when the property was transferred by a Decree of Descent. Please seek professional legal advice if you are not sure this is the correct form for your situation.

Medical Transportation Forms:

MCC Recipient Notice - Instructions for getting reimbursed for Medical Transportation

MCC Trip Log 2020-2021 - Record your trips used for Medical Appointments

Other State Forms:

Additional State forms can be found at: Minnesota Department of Human Services Website


Document Drop Off Locations (Effective April 10)

Anoka County is now accepting a variety of paperwork at three county locations and only vehicle tab renewals at two others. The locations accepting paperwork including vehicle tab renewals, property tax documents, child support and economic assistance applications, and reporting forms are:

Paperwork that CANNOT be accepted at drop boxes are documents related to legal service, litigation, or court matters. If your child support, economic assistance (EA), or property tax paperwork involves a petition or claim to the Anoka County Attorney, those documents MUST be served on the County Attorney. Please see your child support/EA paperwork for service by mail directions regarding legal proceedings. Questions about legal documents can be directed to the County Attorney’s Office: 763-324-5550.

Paperwork can also be submitted by email to [email protected] You may also mail any paperwork to our mailing address listed on this page.

Contact Us

  1. EZ Info


    Ph: 763-422-7200
    Call this number for Adult and Family intake information.


    Anoka County Government Center


    2100 3rd Ave.
    Suite 400
    Anoka, MN  55303


     

    Adult Intake

      Ph: 763-422-7200
      Fax: 763-324-3620


     

    Child Support

      Ph: 763-324-2420
      Fax: 763-324-3990


    Blaine Human Services Center


    1201 NE 89th Ave.
    Suite 400
    Blaine, MN 55434


     

    Family Intake


      Ph: 763-422-7200
      Fax: 763-324-3630


    Funeral Funds


    Ph: 763-324-2430

    MN Dept. of Human Services Website