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The document is a Change Report Form from the Minnesota Department of Human Services, designed for individuals to report changes that may affect their eligibility or benefit levels for cash assistance, health care, or SNAP benefits. It outlines the types of changes that need to be reported, such as changes in address, household composition, income, shelter costs, and other relevant information. The form includes instructions on how to complete it and emphasizes the importance of reporting changes within specified timeframes to avoid penalties for fraud.

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How do I change my address on my EBT card in Minnesota?

If you are moving, you should report your new address ASAP to make sure you dont miss any important letters. To report changes, call your caseworker or the Minnesota SNAP hotline: 1-800-657-3698.

What is the household report form for benefits in Minnesota?

DHS 2120 Household Report Form - This form is for people currently open on Cash or SNAP programs that need to complete a monthly household report form. DHS 5576 Combined Six Month Report - This form is for people currently open on Cash, SNAP, or Healthcare that are required to complete a six month review.

How do I send forms to Hennepin County?

How to submit forms and documents and update your information Update information and upload documents to InfoKeep. Upload to MNbenefits. Fax to 612-288-2981. Mail to: Hennepin County Human Services Department. P.O. Box 107. Minneapolis, MN 55440.

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