The Minnesota Household Report Form, DHS-2120, is the monthly form that keeps certain cash and food assistance cases open. You report the prior month’s income, household changes, assets, and shelter costs; your county or tribal agency uses it to set your next benefit. Sign it on or after the last day of the report month and get it to the agency by the 8th of the following month.
Who Files the DHS-2120
Monthly reporting with the DHS-2120 applies to a specific group. Minnesota Supplemental Aid recipients file monthly. General Assistance recipients with less than $100 in monthly earned income file monthly. Housing Support Program recipients who don’t meet the earned-income and program criteria for six-month reporting also file monthly.
If you’re on MFIP, you don’t use this form; MFIP households file the Combined Six-Month Report (DHS-5576) instead. Most SNAP households also use the six-month report, and elderly or disabled SNAP recipients with no earned income are exempt from six-month reporting entirely.1Minnesota Department of Human Services. Combined Manual 0007.03.02 – Six-Month Reporting If you’re not sure which track you’re on, your county worker can tell you.
If the county mailed you a DHS-2120 with your report month pre-printed, use that copy. Otherwise you can download it from the DHS eDocs library at edocs.dhs.state.mn.us or pick one up at your county human services office. It runs two pages and is available in English and several other languages.
The Deadline
The completed form must reach your county agency by the 8th calendar day of the month after the report month.2Minnesota Department of Human Services. Combined Manual 0007.03.03 – Monthly Reporting Deadlines For a March report month, that means April 8. The rule is receipt, not postmark. If you’re mailing, send it early.
What Goes on the Form
Pull your paystubs, benefit letters, and any records of income or expenses for the report month before you start. Blanks and estimates invite follow-up requests that slow everything down.
Household Members
Did anyone move in or out during the report month, including a newborn? If yes, write the person’s name and the date of the change. Household size feeds directly into your benefit amount.
Rent Subsidy
If you got a new rent subsidy or your existing one changed during the report month, check yes, write in the new amount, and attach proof such as a letter from your housing authority.3Minnesota Department of Human Services. DHS-2120-ENG Household Report Form
Unearned Income
Report any money anyone in your household received that didn’t come from a job: Social Security, child support, unemployment, pensions, and the like. List who got it, how much, and the date. Attach a benefit letter or bank statement showing the deposit.
Earned Income
List every job anyone in the household held during the report month. Write the employer’s name, gross earnings for each pay period, and the dates paid. Include self-employment. Attach all paystubs or other proof of gross earnings. Caseworkers look at this section hardest. If the paystubs don’t match what you wrote, expect a call or a notice.3Minnesota Department of Human Services. DHS-2120-ENG Household Report Form
Assets
The form asks whether your household’s total assets (cash, bank accounts, stocks, bonds, and vehicles) come to $9,800 or more. If yes, list each asset and its value. If no, check no and move on.3Minnesota Department of Human Services. DHS-2120-ENG Household Report Form
Signing: Watch the Date
You cannot sign the form before the last day of the report month. If March is your report month, the earliest valid signature date is March 31.3Minnesota Department of Human Services. DHS-2120-ENG Household Report Form A handwritten signature works on paper; a legally recognized electronic signature works for online submission. An unsigned form is treated as incomplete and will not be processed, which can stop your benefits.
How to Submit It
You can get the signed form and supporting documents to your county or tribal agency several ways:
- Upload scanned copies or clear phone photos through the MNbenefits portal at mnbenefits.mn.gov; the site walks you through matching documents to your case.4MNbenefits. Ready to Upload Documents
- Mail the packet to your county human services office using the address on the form or on correspondence from your worker.
- Drop it off in person; many county offices have secure drop boxes available after hours.
- Fax it to the number on your agency correspondence.
Keep a copy of everything you send. If a dispute comes up later about what you reported, your copy is your proof.
If the Form Is Late or Missing
When the form doesn’t arrive by the 8th, the state’s MAXIS eligibility system automatically generates a termination notice. That notice has to go out at least 10 days before benefits actually close, which gives you a short window to act.2Minnesota Department of Human Services. Combined Manual 0007.03.03 – Monthly Reporting Deadlines
Benefits can still be reinstated if you submit a complete Household Report Form, Combined Six-Month Report, or new Combined Application Form during the calendar month after the form was originally due.5Minnesota Department of Human Services. Combined Manual 0007.03.06 – Processing a Late HRF Miss that window and reinstatement is off the table; you’d have to reapply from scratch. The form puts it plainly: “Fill out and return this form or your benefits may be late or stop.”3Minnesota Department of Human Services. DHS-2120-ENG Household Report Form
If You Disagree With a Decision Based on the Form
The form itself warns that the agency “may deny or change your cash or health care and/or food benefits because of information you give on this form” and “can make changes without giving you 10 days advance notice.”3Minnesota Department of Human Services. DHS-2120-ENG Household Report Form If a change is wrong, you can request a state fair hearing.
File a written request within 30 days of the decision notice. SNAP appeals can also be made by phone. You can file by mail, fax, in person, or online using form DHS-0033. Written requests go to the DHS Appeals Division, PO Box 64941, St. Paul, MN 55164-0941; the office can be reached at 651-431-3600 or by fax at 651-431-7523.6Minnesota Department of Human Services. Appeals If you request the hearing before your benefits actually stop, you may be able to keep receiving them at the current level while the appeal is pending. Ask the Appeals Division about continued benefits when you file.