Alcohol, drugs and addictions
Submit documentation of your household size and income
If you need to submit documentation of your household size and household income because your case was selected as part of our Program Integrity Audit, this is the place for you. You will know whether or not you were selected by reviewing your Behavioral Health Fund (BHF) Application Approval Notice (DHS-2780C) in the last section of the form: Program Integrity.
This documentation needs to be submitted within 60 days of the date on your Behavioral Health Fund (BHF) Application Approval Notice (DHS-2780C). You may submit this documentation by completing Behavioral Health Fund (BHF) Income and Household Size Documentation Request form.
Income and Household Size Documentation Request (PDF)
Form: DHS-2780D
How to submit documentation of your household size and income
Choose how you want to apply: Online, download and upload or download and print.
Download, fill in and upload
The form can be:
- Printed (and completed in writing) and then scanned and uploaded
- Completed electronically, saved and then uploaded
Form(s): DHS-2780D
Print the form and mail it in
Prefer paper? Print the form, complete it in writing and mail it to the address below.
Minnesota Department of Human Services
Attn: BHF request
540 Cedar St.
St. Paul, MN 55101-0977
Print the document request form (PDF)
Form: DHS-2780D