Certain forms must be given to all applicants. Other forms are required based on the program(s) being applied for. If the program(s) being applied for is known, forms for those programs can be given in the application packet or at the interview, if one is required. If the interview is conducted over the phone, send the required forms by mail.

PAPER APPLICATION PACKETS

Counties and tribes must have paper application packets available to give or send to clients.

The following are required to be included in the paper application packet:

●	Combined Application Form (CAF) (DHS-5223) (PDF). Attached to the CAF and the Supplemental Nutrition Assistance Program (SNAP) Application for Seniors (Individuals and couples age 60 and older) (DHS-5223F) (PDF) are the following: - Notice of Privacy Practices (DHS-3979) (PDF). - Client Responsibilities and Rights (DHS-4163) (PDF). - Notice About Income and Eligibility Verification System and Work Reporting System (DHS-2759) (PDF). - Important Information (DHS-3353) (PDF).
●	A cover letter including the following: - The county agency address, office hours, and phone number. - The importance of returning page number 1 of the CAF as soon as possible. - Information about the interview and returning the remainder of the CAF.
●	Program information brochure for cash, food, child care and health care programs (DHS-2920) (PDF).
●	Domestic Violence Information (DHS-3477) (PDF). See 0029.36 (Domestic Violence Brochure).
●	Do you have a disability? (DHS-4133) (PDF). Also see 0003.09.03 (Clients Rights - Civil Rights).

The following may also be included in the application packet or handed out at the interview as appropriate:

●	Household Report Form (DHS-2120) (PDF).
●	Combined Six-Month Report (CSR) (DHS-5576) (PDF).
●	Change Report Form (DHS-2402) (PDF) for cash programs. The Change Report Form for the Supplemental Nutrition Assistance Program (DHS-2402B) (PDF) may only be given to Change Reporting units for SNAP. See 0007 (Reporting), 0007.12 (Agency Responsibilities for Client Reporting), 0007.15 (Unscheduled Reporting of Changes - Cash), 0007.15.03 (Unscheduled Reporting of Changes - SNAP).
●	Authorization for Release of Information About Residence and Shelter Expenses (DHS-2952) (PDF), if appropriate. See 0010.18 (Mandatory Verifications).
●	Application for Social Security number (SS-5), if needed. See 0010.18.03 (Verifying Social Security Numbers), 0012.03 (Providing/Applying for an SSN).

ELECTRONIC APPLICATION PACKETS VIA MNbenefits

Regardless of the program(s) being applied for, MNbenefits applicants have access to the following forms within MNbenefits.

●	Program information for cash, food, and child care programs (DHS-2920) (PDF).
●	Do you have a disability? (DHS-4133) (PDF).
●	Notice of Privacy Practices (DHS-3979) (PDF).
●	General Assistance (DHS-2062) (PDF).
●	Minnesota’s Diversionary Work Program (DHS-4034) (PDF).
●	Minnesota Family Investment Program (DHS-3179) (PDF).
●	Minnesota Supplemental Aid (DHS-1888) (PDF).
●	Supplemental Nutrition Assistance Program (DHS-2814) (PDF).

MNbenefits applicants have access to required forms for the program(s) for which they applied. Applicants must check the box in front of each form attesting they have reviewed the materials before the MNbenefits application can be submitted:

●	Notice of Privacy Practices (DHS-3979) (PDF).
●	Client Responsibilities and Rights (DHS-4163) (PDF).
●	Authorization for Sharing Information and Assignment of Benefits.
●	Notice About Income and Eligibility Verification System and Work Reporting System (DHS-2759) (PDF).
●	Important Information (DHS-3353) (PDF).
●	Additional Important Information.
●	Penalty Warnings.
●	Employment Services Registration.
●	Domestic Violence Information (DHS-3477) (PDF).
●	Do you have a disability? (DHS-4133) (PDF).
●	How to Use Your Minnesota EBT Card (DHS-3315A) (PDF).
●	Civil Rights Notice.
●	Supplemental Nutrition Assistance Program reporting responsibilities (DHS-2625).
●	Facts on Voluntarily Quitting Your Job If You Are on the Supplemental Nutrition Assistance Program (SNAP) (DHS-2707).

ADDITIONAL PROGRAM SPECIFIC FORMS

Give the following forms/handouts based on the programs applied for and the circumstances of the case at the interview or send them out if the interview is conducted over the phone. Check the cross-referenced sections for procedures for each form/handout listed.


MFIP:

●	Reporting Responsibilities for MFIP Households (DHS-2647) (PDF). See 0007.12 (Agency Responsibilities for Client Reporting).
●	In cases where there is at least 1 non-custodial parent: - Understanding Child Support - A Handbook for Parents (DHS-3393) (PDF). - Referral to Support and Collections (DHS-3163B) (PDF). (This is in addition to the Combined Application Form or MNbenefits application, for EACH non-custodial parent). See 0012.21.03 (Support From Non-Custodial Parents). - Cooperation with Child Support Enforcement (DHS-2338) (PDF). See 0012.21.06 (Child Support Good Cause Exemptions). NOTE: This does not apply to a married parent who is out of the home on military duty when there is no breakdown in the marital relationship.
●	Notice of Requirement to Attend MFIP Overview (DHS-2929) (PDF). See 0028.09 (ES Overview/SNAP E&T Orientation).
●	If there is a custodial parent under 20, the Notice of Requirement to Attend School (DHS-2961) (PDF) and Graduate to Independence - MFIP Teen Parent Informational Brochure (DHS-2887) (PDF). If there is a custodial parent under age 18, the MFIP for Minor Caregivers (DHS-3238) (PDF) brochure. See 0012.06 (Requirements for Caregivers Under 20), 0028.06.03 (Who Must Participate in Empl. Services/SNAP E&T), 0028.12 (Education Requirements).
●	Family Violence Referral (DHS-3323) (PDF) and Domestic Violence Information (DHS-3477) (PDF).
●	If a non-parental caregiver applies, MFIP Child Only Assistance (DHS-5561) (PDF).
●	For all applicants, How to Use Your Minnesota EBT Card (DHS-3315A) (PDF).

DWP:
Follow MFIP, EXCEPT do not give the Notice of Requirement to Attend MFIP Overview (DHS-2929) (PDF) to the applicants. Instead, give the applicant the Minnesota’s Diversionary Work Program-DWP (DHS-4034) (PDF).


SNAP:

For all applicants give and verbally review the forms/information below during the interview. Document in MAXIS case notes all information provided. Any forms that are personalized for the unit must also be saved in the case file.

●	The Supplemental Nutrition Assistance Program reporting responsibilities (DHS-2625) (PDF).
●	The Client responsibilities and rights (DHS-4163) (PDF). See 0005.12.12 (Application Interviews), 0007.12 (Agency Responsibilities for Client Reporting) for more information.
●	A SNAP E&T screening must be completed for all unit members ages 16 and older. The applicant can complete the screening for all unit members. Verbally review the information on the SNAP E&T Information and Screening and Referral Questions form (DHS-8493). Document the applicant’s answers to each question on the screening form in MAXIS Case Notes. When the client answers yes to one or both of the questions asked on the SNAP E&T Screening Form, also give them the SNAP E&T Paper Referral.
●	Screen everyone in the unit who is 16 years of age or older for all exemptions from the general work rules and time limits. See 0028.06.12 (Who is Exempt from SNAP Work Registration), 0028.06.15 (Who is Exempt from the SNAP Time-Limited Work Rules), and 0011.24 (Time-limited SNAP Recipients). The SNAP Work Rules Screening Questions (DHS-8456) is not a mandatory form but is a helpful resource to screen for exemptions from the general work rules and time limits. Give the Supplemental Nutrition Assistance Program (SNAP) Work Rules Notice (DHS-8159) (PDF) to anyone who must follow the time-limited work rules and/or general work rules. Indicate on the DHS-8159 who in the unit is subject to the time-limited work rules and/or general work rules.

Give the forms below to all applicants. These forms do not need to be verbally reviewed during the interview.

●	Facts on Voluntarily Quitting Your Job If You Are on the Supplemental Nutrition Assistance Program (SNAP) (DHS-2707) (PDF). See 0028.30.09 (Refusing or Terminating Employment).
●	How to Use Your Minnesota EBT Card (DHS-3315A) (PDF).

If there is student income, also give the Financial Aid Information Form (DHS-2646) (PDF). See 0010.18.30 (Verifying Student Income and Expenses).
If the unit is subject to change reporting requirements, also provide them with the Change Report Form for the Supplemental Nutrition Assistance Program (DHS-2402B) (PDF).


MSA, GA, GRH:

●	SSI Interim Assistance Authorization (DHS-1795) (PDF) and/or Interim Assistance Agreement (DHS-1795A) (PDF), if appropriate. See 0012.12 (Applying for Other Benefits), 0012.12.03 (Interim Assistance Agreements).