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Forms: Numeric List 
F-80000 Through F-89999

This numeric list contains forms that are available from this site.  A PDF - Fillable form can be filled in using your computer and then printed; see About PDF Forms.  Microsoft Word - Fillable or Excel forms, can be filled in, saved, and transmitted electronically. You must have access to Microsoft Office 97, or a more recent version, to use these forms.

Key word explanations for Form Type and Other Location columns.
Division Prefix / Old Form Number Assigned Form Number Form Title Form Type Other Location Language
DMT-0013 F-80013 Petty Cash Fund Annual Report Excel None English
DMT-0015 F-80015 Summary of Depository Funds Annual Report Excel None English
DMT-0025 F-80025 Forms / Publications Requisition Paper Form Center English
DMT-0025A F-80025A Forms / Publications Requisition Word None English
DMT-0025B F-80025B Forms / Publications Requisition Word None English
DMT-0112 F-80112 Vendor Validation Word None English
DMT-0112A F-80112A Vendor Validation Instructions Word None English
DMT-0115 F-80115 Operating Budget Excel None English
DMT-0115A F-80115A Operating Budget Supplement Excel None English
DMT-0122 F-80122 Journal Voucher Excel None English
DMT-0122A F-80122A Journal Voucher Supplement Excel None English
DMT-0130 F-80130 Financial Information (PDF, 90 KB) PDF None English
DMT-0130 F-80130 Financial Information  Word None English
DMT-0130H F-80130H Financial Information - Hmong (PDF, 196 KB) PDF None Hmong
DMT-0130S F-80130S Financial Information - Spanish (PDF, 81 KB) PDF None Spanish
DMT-0130S F-80130S Financial Information - Spanish Word None Spanish
DMT-0138 F-80138 Invoice / Credit Memo Input Excel None English
DMT-0138A F-80138A Invoice / Credit Memo Input Supplement Excel None English
DMT-0138I F-80138i Invoice Credit Memo Input Instructions Word None English
DMT-0141 F-80141 Deposit Voucher Excel None English
DMT-0142 F-80142 Collections Delegation Application Word None English
DMT-0188 F-80188 Check Distribution / Attachments Word Form Center English
DES F-80190 Travel Reimbursement Request Non-State Employee Excel None English
DMT-0190 F-80190 Travel Reimbursement Request Non-State Employee (PDF, 44 KB) PDF None English
DES F-80190A Travel Reimbursement Request State Employee Excel None English
DMT-0455 F-80455 Lease Transmittal Notice Word None English
DMT-0456 F-80456 Operating Lease Agreement Word None English
DMT-0457 F-80457 Lease Agreement Summary Word None English
DMT-0459 F-80459 Client Account Balance Report Excel None English
DMT-0460 F-80460 Account Disclosure Report - Page 1 Voucher Listing - Page 2 Excel None English
DMT-0462 F-80462 Capital Asset Summary Excel None English
DMT-0464 F-80464 Physical and Capital Inventory Compliance Certification Word None English
DMT-0475 F-80475 Department Training Registration Word None English
DMT-0476 F-80476 Asset Transfer Word None English
DMT-0477 F-80477 Canteen Operations Statement of Revenues / Expenses and Fund Equity Changes GAAP Excel None English
DMT-0477A F-80477A Canteen Operations Analysis of Cash GAAP Basis Excel None English
DMT-0477B F-80477B Canteen Operations Balance Sheet - GAAP Basis Excel None English
DES F-80479 Audit Confirmation Request (PDF, 25 KB) PDF None English
DES F-80479 Audit Confirmation Request Word None English
DMT-0601 F-80601 Certification of Claim* (PDF, 18 KB) PDF None English
DMT-0602 F-80602 Electronic Expenditure Report Certification (PDF, 15 KB) PDF None English
DMT-0602 F-80602 Electronic Expenditure Report Certification  Word None English
DMT-0739 F-80739 Prompt Payment Compliance Attachment Excel None English
DMT-0739A F-80739A Prompt Payment Compliance Instructions Word None English
DMT-0751 F-80751 Non-County Resident Proceedings Cost Certification (PDF, 18 KB) PDF None English
DMT-0751 F-80751 Non-County Resident Proceedings Cost Certification Word None English
DMT-0761 F-80761 Contingent Account Activity Report Excel None English
DMT-0762 F-80762 Store Inventory Reconciliation Worksheet Excel None English
DMT-0783A F-80783A Family Financial Questionnaire - County Use (PDF, 30 KB) PDF None English
DMT-0783A F-80783A Family Financial Questionnaire - County Use Word None English
DMT-0806 F-80806 Purchase Requisition Word None English
DMT-0806A F-80806A Bid Solicitation Results Word None English
DMT-0806I F-80806i Purchase Requisition Instructions Word None English
DMT-0855 F-80855 CARS Expenditure Report by Profile  Excel None English
DMT-0855A F-80855A Instructions for Completing Expenditure Report - F-80855 (PDF, 14 KB) PDF None English
DMT-0857 F-80857 Special CARS Run request Word None English
DMT-0862 F-80862 CARS Expenditure Report by Activity Excel None English
DMT-0862A F-80862A Instructions for Completing Expenditure Report - F-80862 (PDF, 14 KB) PDF None English
DMT-0865 F-80865 CARS Expense Adjustment Report Word None English
DMT-0881 F-80881 Profile ID Request (CARS) Word None English
DMT-0881A F-80881A Profile ID Request (CARS) Instructions Word None English
DMT-0882 F-80882 Contract Summary (CARS) Word None English
DMT-0883 F-80883 CARS Contract Adjustment - Extensions and Moves Word None English
DMT-0890 F-80890 BD Workbook (Profile Expense / Budget Summary, Profile Funding Summary, Listing of Expected Contracts, Operating Budget/Supplement)  Excel None English
DMT-0890-CO F-80890-CO BD County Workbook (Profile Expense / Budget Summary, Profile Funding Summary, Listing of Expected Contracts)  Excel None English
DMT-0890A F-80890A Profile Expense / Budget Summary, Profile Funding Summary - Instructions (PDF, 24 KB) PDF None English
DMT-0891 F-80891 List of Expected Contracts Excel None English
DMT-0891A F-80891A List of Expected Contracts - Instructions (PDF, 24 KB) PDF None English
DMT-0900 F-80900 Receivables Annual Report Excel None English
DMT-0900A F-80900A Receivables Quarterly Report Excel None English
DMT-0905 F-80905 State Instant Deposit Program Enrollment (PDF, 17 KB) PDF None English
DMT-0905T F-80905T State Instant Deposit Program Enrollment - Tribes / Great Lakes Tribal Council (PDF, 19 KB) PDF None English
DMT-0905T F-80905T State Instant Deposit Program Enrollment - Tribes / Great Lakes Tribal Council Word None English
DMT-0911 F-80911 Limited Term Employment or Project Employment Application (PDF, 47 KB) PDF None English
DMT-0911 F-80911 Limited Term (LTE) Employment or Project Employment Application Word None English
DMT-0911A F-80911A Limited Term (LTE) Employment or Project Employment Application Instructions (PDF, 15 KB) PDF None English
DMT-0921 F-80921 Invoice Request - Print on Buff Paper Word None English
DMT-0921A F-80921A Invoice Request Instructions Word None English
DMT-0921B F-80921B Invoice Request - Supplement Print on BUFF Paper Word None English
DMT-0952 F-80952 Contingency Plan, Health and Human Services Agencies Word None English
DMT-0952A F-80952A Contingency Plan, DHS Regional Offices Word None English
DMT-0962 F-80962 New Capital Asset Record Word None English
DMT-0963 F-80963 Capital Asset Changes / Deletion Record Word None English
DMT-0976 F-80976 Employment and Education History Summary (PDF, 19 KB) PDF None English
DMT-0976 F-80976 Employment and Education History Summary Word None English
DMT-0983 F-80983 Civil Rights Discrimination Complaint (PDF, 19 KB) PDF None English
DMT-0983 F-80983 Civil Rights Discrimination Complaint Word None English
DMT-0983A F-80983A Civil Rights Discrimination Complaint Instructions (PDF, 19 KB) PDF None English
DES F-80983AB Civil Rights Complaint Instructions - Burmese (PDF, 32 KB) PDF None Burmese
DES F-80983AH Civil Rights Compliance Complaint Instructions - Hmong (PDF, 19 KB) PDF None Hmong
DES F-80983AS Instructions for Completing the Civil Rights Complaint Form (PDF, 20 KB) PDF None Spanish
DES F-80983B Civil Rights Complaint - Burmese (PDF, 32 KB) PDF None Burmese
DES F-80983H Civil Rights Compliance Complaint (PDF, 17 KB) PDF None Hmong
DES F-80983S Civil Rights Complaint Form - Spanish (PDF, 20 KB) PDF None Spanish
DES F-80983S Civil Rights Complaint Form - Spanish Word None Spanish
DMT-1009a F-81009A Security Incident Report Word None English
DMT-1011 F-81011 Cash Certification for Contingent, Canteen client / Resident and General Accounts Word None English
HFS-0002 F-82002 Denial of Government Access To Health Care Records (PDF, 13 KB) PDF None English
HFS-0003 F-82003 Denial of Researcher Access To Health Care Records (PDF 14 KB) PDF None English
HFS-0006 F-82006 Employment Application / Applicant Registration Supplement (PDF, 47 KB) PDF None English
HFS-0006 F-82006 Employment Application / Applicant Registration Supplement Word None English
HFS-0009 F-82009 Confidential Information Release Authorization - Generic (PDF, 19 KB) PDF None English
HFS-0009 F-82009 Confidential Information Release Authorization - Generic  Word None English
DES F-82009BU Confidential Information Release Authorization - Burmese (PDF, 34 KB) PDF None Burmese
HFS-0009H F-82009H Confidential Information Release Authorization - Hmong (PDF, 29 KB) PDF None Hmong
HFS-0009II F-82009ii Confidential Information Release Authorization - WIC (PDF, 52 KB) PDF Form Center English
HFS-0009IIH F-82009iiH Confidential Information Release Authorization - WIC - Hmong (PDF, 26 KB) PDF Form Center Hmong
HFS-0009IIS F-82009iiS Confidential Information Release Authorization - WIC - Spanish (PDF, 94 KB) PDF Form Center Spanish
DES F-82009RU Confidential Information Release Authorization - Russian (PDF, 137 KB) PDF None Russian
HFS-0009S F-82009S Confidential Information Release Authorization - Generic - Spanish (PDF, 22 KB) PDF None Spanish
HFS-0009S F-82009S Confidential Information Release Authorization - Spanish Word None Spanish
  F-82009TC Confidential Information Release Authorization for Transportation Complaint Research Word None English
HFS-0018C F-82018C Work Time Absence Record - 2013 Excel - Fillable Form Center English
HFS-0018C F-82018C Work Time Absence Record - 2013 (PDF, 85 KB) PDF Form Center English
HFS-0021 F-82021 Researcher's Request for Confidential Records or Human Subjects Research (PDF, 14 KB) PDF None English
HFS-0064 F-82064 Background Information Disclosure and Instructions (PDF, 55 KB) PDF Form Center English
HFS-0064 F-82064 Background Information Disclosure and Instructions Word Form Center English
HFS-0064H F-82064H Background Information Disclosure and Instructions - Hmong (PDF, 55 KB) PDF None Hmong
HFS-0064H F-82064S Background Information Disclosure and Instructions - Spanish (PDF, 55 KB) PDF None Spanish
HFS-0069 F-82069 Background Info Disclosure Appendix PDF None English
HFS-0069 F-82069 Background Info Disclosure Appendix Word None English
EXS-0263 F-83263 Rehabilitation Review Application and Instructions (PDF, 114 KB) PDF None English
EXS-0264 F-83264 Rehabilitation Review Panel Decision Report Word Program English
EXS-0264A F-83264A Rehabilitation Review Panel Decision Report - Instructions Word Program English
EXS-0265 F-83265 Rehabilitation Review Appeals Report Word Program English
EXS-0265A F-83265A Rehabilitation Review Appeals Report-Instructions Word Program English
EXS-0271 F-83271 Internet Site Evaluation System None English
EXS-0292 F-83292 Small Business Concern Feedback Word None English
EXS-294 F-83294 Partner Endorsement: Joint Statement and Guide to Action Word None English