Dhs 5223 eng-2026

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The DHS-5223-ENG document is a Combined Application Form for individuals seeking Food Support, Cash Assistance, and Health Care Programs in Minnesota. It provides instructions on how to fill out the form, eligibility requirements, necessary documentation, and the application process. The form emphasizes the importance of providing accurate information, reporting changes in circumstances, and understanding rights and responsibilities related to public assistance programs.

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Click ‘Get Form’ to open the DHS 5223 ENG in the editor.
Begin by filling out your personal information on page 1, including your legal name, address, and contact details. Ensure you use black or dark blue ink for clarity.
Proceed to list all household members on pages 3 and 4. Include everyone living with you, even if they are not applying for assistance. If more space is needed, attach additional sheets.
Complete the income and expense sections accurately. Be prepared to provide proof of income and any changes in your financial situation as required.
Review all sections carefully before signing at the end of the form. Make sure all information is correct to avoid delays in processing.

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Dhs 5223 eng-2026

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