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Combined Manual


ISSUE DATE: 08/2013
Revision #10

See 0008 (Changes in Circumstances) for general information on changes, steps to follow when you learn of a change, tracking expected changes, and acting on changes. This section lists information about changes required in addition to that listed in 0008 (Changes in Circumstances).

Some changes require a new Combined Application Form (CAF) (DHS-5223), a Combined Application – Addendum (DHS-5223C), a Minnesota Transition Application Form (MTAF) (DHS-5223E) or a combination of these forms:

Changing from 1 assistance program to another: Usually requires a Combined Application Form (CAF) (DHS-5223) or an Minnesota Transition Application Form (MTAF) (DHS-5223E). See 0005.09.03 (When People Must Complete an Application), 0005.09.06 (When Not to Require Completion of an Application), 0005.12 (Accepting and Processing Applications).

Adding a person to an existing cash assistance unit: Require a Combined Application – Addendum (DHS-5223C). See 0005.09.09 (When to Use an Addendum to an Application).

Changing the client's basis of eligibility for some programs: See 0008.06.03 (Change in Basis of Eligibility).

For more information on the Minnesota Transition Application Form (MTAF) (DHS-5223E), see 0005.10 (Minnesota Transition Application Form (MTAF).


When a parent leaves the home:

Require the client to complete appropriate questions on the Combined Application Form (CAF) (DHS-5223). Also give the client the Cooperation With Child Support Enforcement (DHS-2338) for the non-custodial parent who left the home.

Give the client Referral to Support and Collections (DHS-3163B) for the non-custodial parent who left the home. Encourage the client to complete the form, but do not require it. See 0012.21.03 (Support From Non-Custodial Parents).

Give or send the client Understanding Child Support, a Handbook for Parents (DHS-3393).

See 0012.21 (Responsible Relatives Not in the Home), 0012.21.06 (Child Support Good Cause Exemptions).


For changes reported or discovered by a method other than on a Combined Six-Month Report (CSR) (DHS-5576), a Combined Six-Month Report Supplement for Cash Programs (CSRS) (DHS-5576A), or a Household Report Form (HRF) (DHS-2120), process the changes as soon as notice provisions permit.


Do not terminate benefits solely because the client does not verify a change in housing, utility, or medical expenses.

For decreased housing or medical expenses the client does not verify, budget the change if it reduces the benefits. Verify the change at recertification time.

For increased housing or medical expenses the client does not verify, do not budget the increased amount. Verify the change at recertification time.

Request an addendum to add a person to an assistance unit, but do not deny or terminate assistance for failure to submit it. If the client does not complete the addendum, record relevant information provided by the client on an addendum form and file it in the case record. Offer the unit the right to change the principal wage earner if the person being added or removed is an adult parent with children (of any age) in the home or the adult has parental control over children in the home. See the description of principal wage earner in 0028.03.06 (Determining SNAP Principal Wage Earner).

Provide change reporting units with a Change Report Form (DHS-2402) for reporting the required changes. See 0007.12 (Agency Responsibilities for Client Reporting), 0007.15.03 (Unscheduled Reporting of Changes - SNAP).


For changes reported or discovered by a method other than on an HRF, process changes as soon as possible. When processing an addendum to add a new person to a unit, use the same time frame allowed for applications. See 0005.12.15 (Application Processing Standards).

© 2018 Minnesota Department of Human Services
Updated: 8/13/13 9:11 AM