DHS-0000-record-detail 1-26 (1.7.1)

Document List - Record Detail

Document information
People
Advertisement
Printing
Electronic document
Standard content
Translation
Project
Security
Connections
Form functionality
Obsolete information

Document information

DHS NUMBER

Enter number similar to 'DHS-1234', 'DHS-1234A' or 'DHS-1234AA'

People

Document owner

EMAIL ADDRESS

FIRST NAME

LAST NAME

AGENCY

ADMINISTRATION or SERVICE LINE

DIVISION or FUNCTION

Communications

COMMUNICATION OFFICER

EMAIL ADDRESS

CO First Name

CO Last Name

DESIGNATED APPROVER

EMAIL ADDRESS

DA FIRST NAME

DA LAST NAME

Designer/Developer

FIRST NAME

LAST NAME

VENDOR NAME

PHONE NUMBER

EMAIL ADDRESS

DELIVERY DATE TO VENDOR

AD SIZE - HEIGHT

AD SIZE - WIDTH

FILE FORMAT

COLOR

MEDIA TYPE

Describe other

Printing

Is this printed?

Yes

Delivery date

Total quantity for estimate

Division PO Box

Use or recycle existing stock?

Use

Recycle

Notes

Electronic document

Will this be an electronic document?

Yes

FORMAT

PDF

Fragment library

Image

Web form

Email/HTML/Multimedia

Other

PDF

Fragment library

Image

Web form

Other

Email/HTML/Multimedia

Type of image output

Image size in pixels: Width

Image size in pixels: Height

Describe other type of document

Final file location

eDocs

Document owner

InfoLink

PartnerLink

Public website

SharePoint

iNet

Other

eDocs

Document owner

InfoLink

PartnerLink

Public website

SharePoint

iNet

Other

Describe other location

Should this be searchable on eDocs?

Yes

When should this be published to eDocs?

DATE

DESCRIPTION (Be brief – one or two sentences)

Be brief – one or two sentences should be sufficient.

KEYWORDS (Separate each word or phrase with a comma)

Separate each word or phrase with commas.

eDocs web address

Standard content

ADA advisory

Will this document have an ADA advisory?

Yes

Is this part of a packet that already includes the ADA Advisory?

Yes

DHS Number of the document that has the ADA

ADA version

Version 1 – General public

Version 2 – Client of treatment team

Version 3 – Client of PCA agency

Version 4 – Client of county worker

EMAIL ADDRESS

PHONE NUMBER

TOLL FREE NUMBER

Name of person or group for information entered

Language block

Will this have a language block?

Yes

Is this part of a packet that already includes the language block?

Yes

DHS number of the document that has the LB

Language block version

LB1

LB2

LB-0001

Is this the first time that LB1 is being used for this document?

Yes

PHONE NUMBER

TOLL FREE NUMBER

Use blank, fillable field

Name of group for information entered

Civil rights block

Will this document contain information about filing complaints or rights and responsibilities or is an application, renewal or change form?

Yes

Select the appropriate complaint block (CB)

CB1 – SNAP program

CB2 – Food and cash programs

CB3 – Health care and medical

CB4 – Social services programs

CB5 – Managed health care

CB6 – Multiple programs (i.e. Health care, food, cash)

CB7 – DHS and MNsure

AUXILIARY AIDS AND SERVICES: PHONE NUMBER

LANGUAGE ASSISTANCE SERVICES: PHONE NUMBER

Translation

Does this need to be translated?

Yes

Amharic

Arabic

Bosnian

Burmese

Chinese (Cantonese)

Chinese (Mandarin)

Chinese (Simplified)

Chinese (Traditional)

Croatian

Dari

French

Haitian

Hmong

Karen

Khmer

Kinyarwanda

Korean

Kurdish

Lao

Nepali

Oromo

Pashto

Russian

Serbian

Serbo-Croatian/Bosnian

Somali

Spanish

Swahili

Ukrainian

Vietnamese

Other

DESCRIBE OTHER LANGUAGE(S)

TRANSLATION NOTES

Project

Is this form part of an agency technical (Gateway) project?

Yes

I don't know

SCIFORMA PROJECT NUMBER

PROJECT MANAGER NAME

Security

DATA TYPES

Protected Health Information (PHI)

Electronic Health Records (EHR)

Federal Tax Information (FTI)

Criminal Justice Information (CJI)

Government issued ID numbers (e.g., social security numbers, driver's license numbers, state ID cards, passport numbers)

Payment Card Industry (PCI) Account Data

Employee Personnel Information

Continuity of Operations Planning (COOP) documents

Confidential Information

Private Information

DATA CLASSIFICATION

TYPE OF USERS

Connections

CRM

Data Warehouse

EDMS Filenet

Email server

Email encryption

ESB

IOC

MAXIS

METS

MMIS

MN-ITS Mailbox

NetStudy

SharePoint

SIR

SQL Database

NOTES

Form functionality

Address verification

Anonymous user gets DoR

Attachments

Calculations

Captcha

Data lookup

Data collection

DoR

Item load path

Repeating data

Signature (Checkbox)

Signature (Scribble)

Store and retrieve

Submit receipt

URL parameter populates form

User authentication

Workspace

Front end render

Adaptive

HTML

PDF

Layout style

Responsive

Wizard

Accordion

Tabs on left

Tabs on top

Workspace render

Adaptive

PDF from XDP

HTML from XDP

Obsolete information

Print

This document is printed. Is this currently stocked in Forms Fulfillment?

Yes

eDocs

When should this be made obsolete?

How long should the obsolete notice be posted on eDocs?

6 months

12 months

5 years

Indefinite

None

Choose a date

Reason why the notice should not expire

Notice expiration date

Choose the notice that will replace this form:

Version 1 – This document is no longer available. Contact {PHONE} for more information about this document.

Version 1a – This document is no longer available. Contact {GROUP EMAIL ADDRESS} for more information about this document.

Version 1b – This document is no longer available online. Contact {PHONE} if you need a copy.

Version 1c – This document is no longer available on eDocs. To access the information provided in this document, go to {WEB ADDRESS}

Version 1d – This document is no longer available. Contact {PHONE} or {TOLL FREE} for more information about this document

Version 1e – Custom message

Version 2 – This document is temporarily unavailable. Contact {PHONE} for more information about this document.

Version 2a – This document is temporarily unavailable. Contact {GROUP EMAIL ADDRESS} for more information about this document

Version 3 – This document has been replaced by {NUMBER OF REPLACEMENT DOCUMENT}. You will be redirected in 10 seconds. Note the new URL address below for this document.

PHONE NUMBER

TOLL FREE NUMBER

GROUP EMAIL ADDRESS

WEB ADDRESS

CUSTOM MESSAGE

NUMBER OF REPLACEMENT DOCUMENT

Enter a document number like 'DHS-1234', 'DHS-1234A' or 'DHS-1234AA'

LANGUAGE

Document List - Record Detail

Document information

People

Document owner

Communications

Designer/Developer

Advertisement

Printing

Electronic document

Standard content

ADA advisory

Language block

Civil rights block

Translation

Project

Security

Connections

Form functionality

Obsolete information

Print

eDocs