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Combined Manual


ISSUE DATE: 08/2012
Revision #3

Allow good cause from monthly reporting requirements for a month when any of the following factors cause a caregiver to fail to provide the county with a completed Household Report Form (HRF) (DHS-2120) before the end of the month in which the form is due:

The employer delays completion of employment verifications.

A county agency does not help the caregiver complete the HRF when the caregiver asks for help.

A caregiver does not receive an HRF due to a mistake on the part of DHS or the county agency or due to a timely reported change in address, which does not allow enough time for MAXIS to send documents to the current address.

A caregiver is ill or physically or mentally disabled.

Some other circumstance occurs that a caregiver could not avoid with reasonable care which prevents the caregiver from providing a completed HRF before the end of the month in which the form is due.

Allow up to an additional 10 days for the client to provide verifications. Assist clients in obtaining needed verifications. A client statement is also permissible if the client, with the county's assistance, is unable to provide necessary verification.


No provisions.

© 2018 Minnesota Department of Human Services
Updated: 8/1/12 6:25 AM