Public Assistance Forms
AREP Authorization form for SNAP, CASH, Medical (DOC) Opens a New Window. - This form is used to designate an authorized representative of your choosing who can communicate with Economic Assistance.
DHS 2243 Authorization for Release of Information about Assets - This form is used to allow a bank or other financial institution to share information about your assets.
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.
DHS 7823 Authorization to Obtain Information from AVS - This form allows the Account Validation Service to provide information about your assets for the MA program to Anoka County.
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.
GEN 260 Sponsor Release of Information - This form is used to allow Economic Assistance to communicate with the client's sponsor.
GEN 280 Drug Felony Release form - This form is used to allow Economic Assistance to obtain information regarding drug test results.
GEN 375 Voicemail Release - This form is used to allow Economic Assistance to leave a detailed message on a voicemail system for a specific phone number.
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.
GEN 262 Special Diets - This form is used to provide information regarding diets prescribed by a doctor.
GEN 335 General Assistance Advanced Age Form - This form is used to verify a person meets the advanced age guidelines for General Assistance.
DHS 5893 Application for Certificate of Clearance for Medical Assistance Claim - Transfer on Death Deed (PDF) Opens a New Window. - 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) Opens a New Window. - 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
MNsure Application Help:
Applying for MNsure Helpful Information - This document gives you step by step instructions for completing an online MNsure application.
Request for Waiver, Assisted Living, or Nursing Home Services (current MA recipients):
DHS 3543 Request for Payment of Long Term Care Services - This form is for people currently open on Medical Assistance (MA) that need waiver services, assisted living services, or nursing home services paid.
Other State Forms:
DHS 8107 Household Update Form - This form is for people currently open on Cash or SNAP programs that need to complete a review following the COVID emergency
DHS 2120 Household Report Form - This form is for people currently open on Cash or SNAP programs that need to complete a monthly household report form.
DHS 5576 Combined Six Month Report - This form is for people currently open on Cash, SNAP, or Healthcare that are required to complete a six month review.
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:
- Anoka County Government Center, 2100 3rd Ave., Anoka
- Blaine Human Service Center, 89th Ave. NE
- City Hall, Ramsey, 7550 Sunwood Dr. NW (Use drive-thru behind building on Veterans Drive)
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.
Call this number for Adult and Family intake information.
Anoka County Government Center
2100 3rd Ave.
Anoka, MN 55303
Adult IntakePh: 763-422-7200
Child SupportPh: 763-324-2420
Blaine Human Services Center
1201 NE 89th Ave.
Blaine, MN 55434
MN Dept. of Human Services Website