DHS-5576-ENG (Combined Six-Month Report). This form is sent to clients who have a six-month renewal for health care eligibility or a six-month report for the Supplemental Nutrition Assistance Program (SNAP) due. When used, this form also meets any mo-2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in your personal information in Section 1, including your name, address, date of birth, and phone number. Ensure all details are accurate.
3. In Section 2, indicate if anyone has moved in or out of your home in the past six months. If yes, provide their details as requested.
4. Proceed to Section 3 to report on health care coverage. Answer whether anyone is receiving benefits through Medical Assistance or Medicare Savings Program.
5. Continue through Sections 4 to 12, providing information about employment status, income sources, assets, and any changes since your last application.
6. Finally, review all sections for completeness and accuracy. Sign and date the form before submitting it back to your county agency.

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