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ISSUE DATE: 08/2015

All applicant households must complete an application. For information on setting the application date, see 0005.12.09 (Date of Application). If a client returns page number 1 of the Combined Application Form (DHS-5233) (PDF) (CAF) or submits an ApplyMN application with the program code UNKWN in the file name but fails to return the remainder of the CAF or come for an interview, deny the application 30 days after the date on page number 1 of the CAF or ApplyMN application. See 0005.12.12 (Application Interviews), 0026.15 (Notices of Denial, Termination, or Suspension).

A complete application is a signed and dated application with all questions answered, with the EXCEPTIONS for SNAP and MFIP noted below. See 0005.09 (Combined Application Form (CAF)), 0005.12.06 (Who Must Sign Applications).

The only time you may return page number 1 of the CAF is when the necessary signatures are incomplete or missing. Complete other missing or incomplete information on the CAF at the time of interview.

When an ApplyMN application has missing or incomplete information, complete the missing or incomplete information at the time of the interview. If additional signatures are needed, obtain them at the time of the interview or send the applicant page 9 of the CAF.

Counties which have fax machines may accept faxed applications. When you get a faxed page number 1 of the CAF or the entire CAF, enter the information on MAXIS. Deny an application after 30 days if the applicant fails to attend a required application interview.

Consider faxed applications you get on weekends, holidays, or after hours to be received on the same day as the fax date stamp of the application. If the fax machine is located outside the human services agency, the county will need to address data privacy issues for applicants.

The client is responsible for verifying the county received the fax.


Relative caregivers who choose not to receive MFIP for their own needs have the option of answering only those questions relevant to determining eligibility for the children for whom they are applying.


Follow general provisions.


Clients have the option of answering only those questions relevant to the SNAP program.

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