The Combined Application – Child Care Addendum (DHS-5223D) (PDF) form is a tool designed to simplify the child care assistance application process for families applying for cash assistance and/or Supplemental Nutrition Assistance Program (SNAP). The Combined Application Form requests information about the family’s composition, income, and assets. The Child Care Addendum asks for information about the family’s activities and need for childcare. The two forms work together as an application for child care assistance.

Use the Child Care Addendum when:

When using the Child Care Addendum, apply child care policy rules and verification requirements. Request copies of current verification, documentation and information reported on the Combined Application Form 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 (DHS-3550) (PDF).

Legal authority

Minnesota Statutes 119B.011, Subd. 3