How to Complete Form DHS-2623: Submission, Processing, and Appeals

The Minnesota Department of Human Services keeps its application, change-reporting, and appeal forms in an online library called eDocs, hosted at mn.gov/dhs. Minnesota DHS eDocs forms are PDFs — many of them fillable — organized by form number, topic, and language, and you can download them free.1Minnesota Department of Human Services. Searchable Document Library (eDocs) Getting the right form, filling it out cleanly, and submitting it with the required verifications is what separates an application that moves in days from one that stalls for weeks.

How to Search the eDocs Library

The fastest search is by form number. Every DHS form has an alphanumeric code — DHS-6696 for the combined health care and benefits application, DHS-2402 for the cash-program change report, DHS-0033 for an appeal — and typing the code into the eDocs search bar pulls up the exact document instead of a page of loosely related results.1Minnesota Department of Human Services. Searchable Document Library (eDocs)

If you don’t know the number, use the filters. You can narrow by date range or by topic (groupings like “Minnesota Health Care Programs” and “HIPAA and privacy-related forms”), and by language. eDocs carries translations in roughly 28 languages, including Spanish, Hmong, Somali, Russian, Arabic, Vietnamese, Karen, Amharic, Burmese, Nepali, and Oromo.1Minnesota Department of Human Services. Searchable Document Library (eDocs)

Stuck? The eDocs help desk answers questions at dhs.edocs.helpdesk@state.mn.us.1Minnesota Department of Human Services. Searchable Document Library (eDocs)

Forms Most People Need

A handful of forms account for most eDocs downloads. Knowing which one applies to your situation before you start searching avoids the common mistake of filling out the wrong document.

  • DHS-6696, the combined application for health coverage and help paying costs. This is the starting point for Medical Assistance (Medicaid) and MinnesotaCare.
  • DHS-2243, Authorization for Release of Information About Assets, used when DHS needs to verify financial accounts to determine eligibility.2Itasca County. DHS-2243-ENG Authorization for Release of Information About Assets
  • DHS-2402, the Change Report Form for cash assistance. Use it to notify the county when your income, household size, or living situation changes after approval.3Minnesota Department of Human Services. Forms/Handouts for Applicants
  • DHS-0033, Appeal to State Agency, used to request a fair hearing if your application is denied or your benefits are reduced.4Minnesota Department of Human Services. Appeals
  • DHS-3155, the “Your Responsibilities” brochure, which explains what changes you’re required to report and when.5Minnesota Department of Human Services. Reporting Changes

If you’d rather skip the PDF entirely, MNbenefits at mnbenefits.mn.gov lets you complete and submit applications for food, cash, child care, and health care benefits online.6MNbenefits. MNbenefits eDocs is where you go when you want paper, when you need a form MNbenefits doesn’t cover, or when you’re managing an existing case.

What to Gather Before You Start

Under Minnesota Statute 256P.04, the burden is on you to provide evidence verifying your eligibility, and missing paperwork is the most common reason applications stall.7Minnesota Office of the Revisor of Statutes. Minnesota Statutes 256P – Economic Assistance Program Eligibility and Verification The statute lists specific items the county must verify at application:

  • Identity: a government-issued photo ID for every adult in the household.
  • Social Security numbers for each household member. Qualified noncitizens who are domestic violence victims may be exempt.
  • Immigration status documents for any non-citizen applicant.
  • Income: recent pay stubs, a benefit verification letter, tax returns, or an employer statement.
  • Residence: a lease, utility bill, or similar document showing you live in Minnesota.
  • Vehicles: registration or title information for cars and other vehicles the household owns.
  • Bank accounts: statements from checking and savings, including any business accounts used for personal expenses.
  • Child support or spousal support: records of payments made to people outside your household.

The agency can also ask you to clear up anything that looks inconsistent with what it already knows. If a specific document isn’t available right away, the statute allows the agency to accept a signed personal statement explaining why. That buys time, not a permanent pass — expect follow-up.7Minnesota Office of the Revisor of Statutes. Minnesota Statutes 256P – Economic Assistance Program Eligibility and Verification

Filling Out the PDF

Most eDocs forms are PDFs. Some are fillable, letting you type directly into the fields, and some are static, meaning you print and complete them by hand.8Minnesota Department of Human Services. Minnesota DHS eDocs Forms For fillable versions, open the file in Adobe Acrobat Reader or a compatible PDF viewer, and save it to your computer before you start typing. Browser-based PDF viewers sometimes drop entries without warning.

Watch for sections labeled “For agency use only” or “For office use only.” Leave them blank. They belong to the county worker processing your application, and filling them in can slow things down.

A few habits that pay off:

  • Match your ID exactly. Name and date of birth on the form should match your government-issued identification. Small discrepancies trigger verification requests.
  • Sign and date every signature line. Unsigned forms are the single easiest reason for a return.
  • Keep a copy. Save the completed PDF or photocopy the printed form before you submit. If the county disputes what you sent, your copy is your proof.

Every signed DHS form carries a penalty warning: false or misrepresented information can lead to prosecution for fraud under Minnesota Statutes 609.52 and 609.821, or perjury under 609.48.7Minnesota Office of the Revisor of Statutes. Minnesota Statutes 256P – Economic Assistance Program Eligibility and Verification Double-check income and asset figures before signing.

Where to Submit

Where the completed form goes depends on the program and your county. Most applications and supporting documents go to your county or tribal human services office, which handles day-to-day administration. Submission is usually by mail, fax, or in person, and many forms include the relevant address or fax number in their instructions.

For health care, food, cash, and child care applications, MNbenefits accepts everything online with no mailing.6MNbenefits. MNbenefits DHS also runs a separate document upload tool for Medical Assistance renewals, which accepts scanned files or phone photos of your completed renewal.9Minnesota Department of Human Services. Upload Documents

Keep a record of when and how you submitted. If you mailed the form, note the date and consider certified mail. If you faxed it, keep the confirmation page. That log matters if a processing dispute comes up later.

How Long Processing Takes

Timelines depend on the program. These are legal maximums; your county should process faster when it can.

If the county asks for additional documents and you don’t send them, your application can be denied. The clock doesn’t stop while the agency waits, so getting requested items in quickly is the single most effective thing you can do to keep an application on track.

Reporting Changes After You’re Approved

Approval doesn’t end your paperwork. If your income, household size, address, or other circumstances change, you have to report it, and the deadline depends on the program. For Medical Assistance, you have 10 days from the date of the change. For MinnesotaCare (when no one in the household receives MA), the window is 30 days.14MNsure. Reporting Changes for Public Program Coverage

For cash programs like MFIP or General Assistance, use the Change Report Form (DHS-2402) in eDocs.3Minnesota Department of Human Services. Forms/Handouts for Applicants The DHS-3155 brochure lays out exactly which changes matter for your program and is worth reading once when you’re first approved.5Minnesota Department of Human Services. Reporting Changes

Failing to report a change can result in an overpayment you’ll have to repay to the state or federal government.14MNsure. Reporting Changes for Public Program Coverage In more serious cases, such as collecting benefits in two states at once, you could face an intentional program violation finding with disqualification periods and possible criminal prosecution.

If You’re Denied or the County Misses the Deadline

If your application is denied, your benefits are reduced, or the county doesn’t act within the processing deadlines, you can request a fair hearing. Use DHS-0033 (Appeal to State Agency), which you can find in eDocs or complete online. For most programs, appeals must be submitted in writing — by mail, fax, in person, or through the online form. SNAP appeals are the exception: you can file one verbally by calling the DHS Appeals Division.4Minnesota Department of Human Services. Appeals

File quickly. Hearing deadlines vary by program, and filing before your current benefits expire can sometimes keep benefits flowing while the appeal is pending. Your denial notice states the specific reason for the decision and the deadline for requesting a hearing.

Language and Accessibility Options

DHS provides forms and materials in accessible formats on request.

  • General accessible formats: 651-431-2000 or your preferred relay service.
  • Large print or electronic conversion: DHS Graphics Unit at 651-431-3628.
  • Audio or voice recording: State Services for the Blind at 651-642-0500 or 800-652-9000.
  • Braille: also through State Services for the Blind.
  • Disability rights questions: ADA Coordinator at 651-431-3040 (voice), 866-786-3945 (TTY), or dhs.info@state.mn.us.15Minnesota Department of Human Services. Accessibility Statement

Use the language filter on the eDocs search page to see available translations. Not every form is translated into every language, but the most commonly used applications and notices have broad coverage. If you need a form in a language that isn’t listed, call the DHS Information Desk at 651-431-2000 to ask about interpreter services or alternative formats.1Minnesota Department of Human Services. Searchable Document Library (eDocs)