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COMBINED MANUAL
ISSUE DATE 02/2022
FORMS/HANDOUTS FOR APPLICANTS
0005.12.12.01
● Notice of Requirement to Attend MFIP Overview (DHS-2929) (PDF). See 0028.09 (ES Overview/SNAP E&T Orientation).
● If there is a custodial parent under 20, the Notice of Requirement to Attend School (DHS-2961) (PDF) and Graduate to Independence - MFIP Teen Parent Informational Brochure (DHS-2887) (PDF). If there is a custodial parent under age 18, the MFIP for Minor Caregivers (DHS-3238) (PDF) brochure. See 0012.06 (Requirements for Caregivers Under 20), 0028.06.03 (Who Must Participate in Empl. Services/SNAP E&T), 0028.12 (Education Requirements).
● Family Violence Referral (DHS-3323) (PDF) and Domestic Violence Information (DHS-3477) (PDF).
● If a non-parental caregiver applies, MFIP Child Only Assistance (DHS-5561) (PDF).
● For all applicants, How to Use Your Minnesota EBT Card (DHS-3315A) (PDF).
DWP: Follow MFIP, EXCEPT do not give the Notice of Requirement to Attend MFIP Overview (DHS-2929) (PDF) to the applicants. Instead, give the applicant the Minnesota’s Diversionary Work Program-DWP (DHS-4034) (PDF).
SNAP:
For all applicants give and verbally review during the interview: ● The Supplemental Nutrition Assistance Program reporting responsibilities (DHS-2625) (PDF).
● The Client responsibilities and rights (DHS-4163) (PDF). See 0005.12.12 (Application Interviews), 0007.12 (Agency Responsibilities for Client Reporting) for more information.
● Supplemental Nutrition Assistance Program (SNAP) Work Rules Notice (DHS-8159) (PDF). See 0011.24 (Abled-Bodied Adults Without Dependents), 0028.07 (General Work Rules for SNAP).
Give the forms below to all applicants. These forms do not need to be verbally reviewed during the interview. ● Facts on Voluntarily Quitting Your Job If You Are on the Supplemental Nutrition Assistance Program (SNAP) (DHS-2707) (PDF). See 0028.30.09 (Refusing or Terminating Employment).
● How to Use Your Minnesota EBT Card (DHS-3315A) (PDF).
If there is student income, also give the Financial Aid Information Form (DHS-2646) (PDF). See 0010.18.30 (Verifying Student Income and Expenses).
If the unit is subject to change reporting requirements, also provide them with the Change Report Form for the Supplemental Nutrition Assistance Program (DHS-2402B) (PDF).
MSA, GA, GRH: ● SSI Interim Assistance Authorization (DHS-1795) (PDF) and/or Interim Assistance Agreement (DHS-1795A) (PDF), if appropriate. See 0012.12 (Applying for Other Benefits), 0012.12.03 (Interim Assistance Agreements).