Form Center

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Administrative Services

  1. Data Request Form - Members of the Public

    Members of the Public should utilize this form to request data

County Board

  1. Itasca County Committee/Commission/Board Application

    This form is used to apply for positions on Itasca County Committees/Commissions/Boards.

Health & Human Services

  1. Adult Health Intake

    Public health intake form.

  2. Application for Children's Mental Health Respite Grant

    Access the Application for children's mental health respite grant.

  3. Itasca County Rule 79 Child Mental Health Referral

    Access the Children's Mental Health Intake form.

  1. Application for Appointment

    Please fill out an application for an appointment with the Itasca County Health and Human Services Advisory Committee.

  2. Health Care Transportation Reimbursement Form

    Medical provider only completes this reimbursement form.

  3. Medicare Redetermination Request Form

Itasca County

  1. Affidavit of Restitution

    Access the request for restitution and affidavit form.

  2. Itasca County Rule 79 Adult Mental Health Referral

    Access the Adult Mental Health Referral form.

  1. IMCare EFT and ERA authorization agreement

    Fill in the IMCare EFT (electronic funds transfer) and ERA (electronic remittance advice) authorization agreement