Minnesota Confidential Information Form — CHIPS (Form 11.4) is a form used by the Minnesota Department of Human Services to collect confidential information from organizations and individuals in order to issue payments and/or provide services. This form is used to collect information including, but not limited to, Social Security numbers, tax information, driver's license numbers, and financial information. The form is divided into three parts; Part A is for organizations, Part B is for individuals, and Part C is for both individuals and organizations. There are three types of Minnesota Confidential Information Form — CHIPS (Form 11.4): a Minnesota CHIPS Provider Form (Form 11.4a), a Minnesota CHIPS Recipient Form (Form 11.4b), and a Minnesota CHIPS Self-Employed Form (Form 11.4c).
Minnesota Confidential Information Form - CHIPS (Form 11.4)
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How to fill out Minnesota Confidential Information Form - CHIPS (Form 11.4)?
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