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Minnesota Department of Human Services Child Care Assistance Program (CCAP) Policy Manual
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3.9 Combined Application Child Care Addendum

ISSUE DATE: 08/2014

The Combined Application –Child Care Addendum (PDF) (DHS-5223D) form is a tool designed to simplify the child care assistance process for families who have applied for other programs.

Use the Child Care Addendum when:

A family completes the CAF and requests child care assistance. OR

The CAF has been completed and the family is not eligible for cash assistance, but requests child care assistance. OR

The CAF have been completed and approved within the past 90 days and the family is now requesting child care assistance.

Apply child care policy rules and verification requirements. Request copies of current verification, documentation and information reported to determine eligibility for the Child Care Assistance Program.

Use of the Child Care Addendum is optional. You may choose to use the Minnesota Child Care Assistance Program Application (PDF) (DHS-3550).


Minnesota Statutes 119B.011, Subd. 3

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