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DHS5223ENG 1116Combined Application Form
Apply online at www.applymn.dhs.mn.govThis application can be used to apply for
any of the following programs:How to fill out this application
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What is dhs-5223-eng 11-16?
It is a form used for reporting income to the Department of Human Services.
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Anyone who received income that needs to be reported to the Department of Human Services.
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You must report all sources of income including wages, benefits, and any other financial assistance received.
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