Mn dhs 5274-2026

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  1. Click ‘Get Form’ to open the mn dhs 5274 in the editor.
  2. Begin by filling in your personal information, including your name, phone number, and address. Ensure that you include your case number for reference.
  3. In the 'Living situation' section, select the appropriate option that describes your current housing status. If necessary, attach proof of your current address.
  4. List all household members in the designated section. Provide details such as their names, relationships, and any relevant identification proofs if they have recently moved in.
  5. Complete the income section by indicating whether anyone in your household is employed or self-employed. Be thorough and provide accurate figures for all sources of income.
  6. Fill out the child care needs section by listing all children requiring care and specifying their primary and secondary providers along with days and hours needed.
  7. Review all sections carefully to ensure accuracy. Once completed, sign and date the form before submitting it via mail or fax to your child care worker.

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Get details about these programs at the following links: Medical Assistance (MA) is Minnesotas Medicaid program for people with low income. MA does not require you to pay a monthly premium.
Minnesota Family Investment Program (MFIP) - Child Only Assistance. The Minnesota Family Investment Program (MFIP) and Supplemental Nutrition Assistance Program (SNAP) offer benefits for children who are closely related to their caregiver, or the caregiver has custody or guardianship of the child.
In the State of Minnesota, a person may do unlicensed care if they provide services to relatives and one family.

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