DHS Hotline Form
DHS Hotline
DHS requires that reporters leave their name and contact information when filing a report on this hotline. We will contact you using the information below to confirm your submission and may ask for additional or clarifying information. For information on your data privacy, please see the Tennessen Warning section below.

This hotline is managed by the DHS Internal Audits Office. If the concerns reported are not something the Internal Audits Office is delegated to investigate and are within another business area’s responsibility, your concern and contact information may be shared with an appropriate contact. For example, HR Director or EOAD Director.

Thank you for taking the time to complete this form to report your concerns.

If this is an emergency, call 911 and/or the DHS security officers at (651) 431-3000, as appropriate.
Related Policies
To read about a policy, click its link below
Tennessen Warning
This form asks you to give some information about yourself that is considered private or confidential under the Minnesota Government Data Practices Act (Minnesota Statutes Chapter 13). The Minnesota Department of Human Services (DHS) is collecting this information to understand and investigate your concern. You are not legally required to provide information on this form, but if you do not provide information you may fail to comply with DHS policies, and may be subject to discipline, up to and including termination. If you don't provide this information, DHS may not be able to investigate your concern, or get all of the information needed to complete the investigation. The information that you give may be used to take disciplinary or other remedial action, and you may be required to testify at a hearing about that information. The information you provide may be shared with: the subject(s) of the report; DHS employees whose work assignments reasonably require access including, but not limited to, the DHS Ethics Office, Internal Audits, Human Resources, the report subject(s)’ supervisor(s) or manager(s), and your supervisor or manager; the State or Legislative Auditor; the Attorney General; Minnesota Management and Budget; law enforcement agencies with statutory authority; and/or any other person or entity authorized by state or federal law or court order to access the data.
About You
What is your relationship to the MN Department of Human Services? (Required)DHS Employee: All persons, regardless of classification or status, appointed pursuant to Minnesota Statutes Chapter 43A whose work assignment is with the Minnesota Department of Human Services. Clients:People served by MN DHS. Depending on the type of service, other terms may be used, including patient, individual, consumer, or person receiving services.Contractor/Third Party/Vendor:Those persons hired by a contractor as an employee or subcontractor to perform tasks under a DHS contract. This term includes any consultant to DHS who is not actually an employee.Intern/Volunteer:A person who is supervised by a DHS employees and who provides some unpaid service to DHS, usually on a regular schedule.External Stakeholder:The parties or groups that are not a part of the organization, but gets affected by its activities (non-profits, counties and tribes, health providers, MCO’s, other government agencies, grantees, vendors)Community Member:A person who is affiliated with a particular group of people who define themselves as part of a community*
Your First and Last Name (Required)Spacer*
Your E-mail and/or Phone Number (Required)Spacer*
What business area/division do you work in and where is your work location? (Optional)Spacer
Report Incident
Date and Time of Incident (Optional)Spacer
Name(s) of persons involved in the incident being reported (please separate each name by a comma) (Required)Spacer*
Person Involved (Check all that applies) (Optional)DHS Employee: All persons, regardless of classification or status, appointed pursuant to Minnesota Statutes Chapter 43A whose work assignment is with the Minnesota Department of Human Services. Clients:People served by MN DHS. Depending on the type of service, other terms may be used, including patient, individual, consumer, or person receiving services.Contractor/Third Party/Vendor:Those persons hired by a contractor as an employee or subcontractor to perform tasks under a DHS contract. This term includes any consultant to DHS who is not actually an employee.Intern/Volunteer:A person who is supervised by a DHS employees and who provides some unpaid service to DHS, usually on a regular schedule.External Stakeholder:The parties or groups that are not a part of the organization, but gets affected by its activities (non-profits, counties and tribes, health providers, MCO’s, other government agencies, grantees, vendors)Community Member:A person who is affiliated with a particular group of people who define themselves as part of a community
DHS Employee
Client
Contractor/Third Party/Vendor
Recipient
External Stakeholder
Community Member
Volunteer or Intern
Other
Please identify the administration involved:Spacer*
Business or Division of Incident (If Known) (Optional)Spacer
Location of Occurrence (If Known) (Optional)Spacer
DescriptionSpacer*
DHS’ goal is to use these reports to improve internal controls, systems and process. To accomplish this, DHS needs to thoroughly understand your concern.

Please discuss your concern in detail including:
• how the situation or incident happened including any contributing factors or relevant context;
• how it was discovered;
• any remediation efforts that have occurred; and
• anything else you feel is important.

Please do not use acronyms.
Incident DescriptionSpacer
Internal Audits may contact you for additional or clarifying information including for supporting documentation. If you do not provide complete information, Internal Audits may not have enough information to continue its investigation and may close the case.

By submitting this form, you acknowledge that you read the Tennessen Warning, and all the information you provide on this form is accurate to the best of your knowledge.

For questions or concerns, contact the Internal Audits Director, Gary L. Johnson at 651-431-3623 or email the Internal Audits Office at DHS.IAO@state.mn.us.

**Clicking the submit button more than once could result in duplicate submissions of the record**
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Hidden Fields
SubjectSpacer*
From AddressSpacer*
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Do you wish to remain anonymous for this report?Spacer
First Name (Person Involved)Spacer
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