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Child Care Assistance Program Policy Manual Issued 10/2018 Combined Application – Child Care Addendum 3.9 The Combined Application – Child Care Addendum (DHS-5223D) (PDF) form is a tool designed to simplify the child care assistance application process for families applying for cash assistance and/or Supplemental Nutrition Assistance Program (SNAP). The Combined Application Form requests information about the family’s composition, income, and assets. The Child Care Addendum asks for information about the family’s activities and need for childcare. The two forms work together as an application for child care assistance. Use the Child Care Addendum when: • A family completes the Combined Application Form (DHS-5223) (PDF) and requests child care assistance. OR • The Combined Application Form was completed and the family is not eligible for cash assistance and/or SNAP but requests child care assistance. OR • The Combined Application Form was completed and approved within the past 90 days and the family remains eligible for cash assistance and/or SNAP and is now requesting child care assistance. When using the Child Care Addendum, apply child care policy rules and verification requirements. Request copies of current verification, documentation and information reported on the Combined Application Form to determine eligibility for the Child Care Assistance Program. Use of the Child Care Addendum is optional. You may choose to use the Minnesota Child Care Assistance Program Application (DHS-3550) (PDF). Legal authority Minnesota Statutes 119B.011, Subd. 3