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COMBINED MANUAL

ISSUE DATE 12/2014

WITHDRAWING AN APPLICATION

0005.12.18

People may withdraw their application for all or specific assistance programs by 1 of the following methods:

● Oral request.

OR ● Written statement.

OR ● Writing "withdrawn" on the Combined Application Form (DHS-5223) (PDF) (CAF) and initialing it.

OR ● Deselecting the check boxes on the “What Programs is this Person Applying for?” question on page 3 of the CAF for each person, checking the “None” box, and initialing them.

Advise the client of the right to reapply at any time. Confirm the withdrawal by documenting the withdrawal and the reason for it in CASE/NOTEs.

After approving the withdrawal, MAXIS sends a written notice to confirm the withdrawal. Also see 0005.12.21 (Reinstating a Withdrawn Application), 0026.06 (Notice - Approval of Application or Recert.), 0026.15 (Notice of Denial, Termination, or Suspension).

MFIP, DWP, SNAP, MSA, GA, GRH: Follow general provisions.