This is an archived document and does not contain the most current information for this topic. Use this document for reference only.

Minnesota Family Planning Program Application (Archive)

People may apply for MFPP in the following ways.

Minnesota Family Planning Program Application – MFPP (DHS-4740)

People seeking coverage under MFPP submit this form to Minnesota Department of Human Services (DHS).

Presumptive Eligibility with a Certified Provider

The applicant completes the first page and the signature page of the MFPP Application (DHS-4740) at the health care provider’s office. The provider reviews the application and either approves or denies temporary eligibility. See the MFPP Presumptive Eligibility policy for more information.

Application Submission

Minors can apply for MFPP on their own. Minors do not require anyone’s consent to apply for MFPP.

Signature Requirement

Applicants must sign the application. Applicants younger than 19 may apply without the signature of a parent or guardian.


MFPP applicants and enrollees can arrange to receive notices mailed to an address other than their home address.

Legal Citations

Minnesota Rules, parts 9505.5300 to 9505.5325

Minnesota Statutes, section 256B.78