MN DHS-2120-ENG 2013 free printable template
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Clear Form DHS-2120-ENG Household Report Form Case number 12-13 agency name address city/state/zip client name address city/state/zip How to fill out this form 1. Your REPORT MONTH S is 2. Fill out and return this form or your benefits may be late or stop* 3. Answer Yes or No to each question* 4. If there is not enough room on the form to answer a question attach your own pages. 5. Sign and date the form on or after ADA5 12-12 This information is available in accessible formats for...
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How to fill out MN DHS-2120-ENG
How to fill out MN DHS-2120-ENG
01
Begin by downloading the MN DHS-2120-ENG form from the official website.
02
Fill in your personal information including your name, address, and contact details in the appropriate sections.
03
Provide information about your household members, including their names and relationships to you.
04
Indicate your income sources and amounts, including wages, benefits, and any other earnings.
05
Complete the section on expenses, detailing your monthly rent/mortgage, utilities, and other costs.
06
Review the form to ensure all sections are filled out accurately.
07
Sign and date the form at the bottom.
08
Submit the completed form to the designated address provided in the instructions.
Who needs MN DHS-2120-ENG?
01
Individuals or families applying for financial assistance programs in Minnesota.
02
Those seeking to determine their eligibility for health care programs, food support, or cash assistance.
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How do I contact MN DHS?
Questions and comments about the dashboard can be sent to: DHS.info@state.mn.us.Contact us Call the DHS Information Desk at 651-431-2000 (TTY/TDD service: 800-627-3529) Minnesota Health Care Program (MHCP) enrolled health care providers can call the Provider Resource Center at 651-431-2700 or 800-366-5411.
How do I file a complaint with Mn DHS?
Call the OMHDD: 651-757-1800 or 1-800-657-3506.
What is the Minnesota Department of Health Human Resources phone number?
Service Details Visit the website, or call (866) 333-2466 (8:30am - 5:00pm, Monday - Friday) for more information.
What are the phone numbers for MinnesotaCare?
How do I apply for MinnesotaCare? Request an application by calling MinnesotaCare at (651) 297-3862 (Twin Cities Metro) or 1-800-657-3672 (toll-free). For TTY call 711 or 1-800-627-3529.
What is the combined application form MN?
The Combined Application Form (CAF) (DHS-5223) (PDF) allows people to apply for multiple assistance programs on 1 form. Minnesota Family Investment Program (MFIP). Refugee Cash Assistance (RCA). Diversionary Work Program (DWP).
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What is MN DHS-2120-ENG?
MN DHS-2120-ENG is a form used by the Minnesota Department of Human Services (DHS) for individuals to report their income and expenses for public assistance programs.
Who is required to file MN DHS-2120-ENG?
Individuals applying for or receiving public assistance benefits in Minnesota, such as cash assistance or food support, are required to file MN DHS-2120-ENG.
How to fill out MN DHS-2120-ENG?
To fill out MN DHS-2120-ENG, you need to provide accurate information about your household's income, expenses, and other relevant details as prompted in the form. Make sure to read the instructions carefully.
What is the purpose of MN DHS-2120-ENG?
The purpose of MN DHS-2120-ENG is to gather necessary financial information from applicants or recipients to determine eligibility and calculate benefits for assistance programs.
What information must be reported on MN DHS-2120-ENG?
Information that must be reported on MN DHS-2120-ENG includes details about household income, expenses, assets, and any other information relevant to determining eligibility for public assistance.
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