Minnesota Combined Application Form (DHS-5223): Documents, Filing, and Next Steps

The Minnesota Combined Application Form, DHS-5223, is a single 11-page document that lets you apply for SNAP, cash assistance, and other state safety-net programs at once. You fill it out, sign it, and send it to your county or Tribal Nation human services office; the agency screens you for every program you might qualify for. You can download the form from the Minnesota Department of Human Services website, pick up a paper copy at any county human services office, or skip paper entirely and apply online at mnbenefits.mn.gov.¹²

What the Form Covers

You do not need to decide in advance which programs to apply for. The agency uses what you write on the DHS-5223 to check your eligibility for all of them. The form covers:

Supplemental Nutrition Assistance Program (SNAP) food benefits, loaded onto an EBT card.³
Minnesota Family Investment Program (MFIP), which combines cash and food assistance with employment services for families with minor children.⁴
Diversionary Work Program (DWP), a four-month cash and job-search program for families with children.⁵
General Assistance (GA), a monthly cash grant of $360.50 for adults without children who cannot work enough to support themselves.⁶
Minnesota Supplemental Aid (MSA), extra monthly cash for adults who are aged, blind, or disabled and receive (or nearly qualify for) SSI.⁷

Medical Assistance and MinnesotaCare are separate applications and are not covered by the DHS-5223.

Documents to Gather First

Having your paperwork in front of you before you start saves a round of back-and-forth later. Pull together the following.

Identity and Household

You need the Social Security number, date of birth, and citizenship or immigration status for every person in the household who is applying. Non-citizens should have copies of both sides of their immigration cards or other status documents. Immigration information is classified as private and will not be shared with USCIS without your written permission. Non-citizens can also apply on behalf of eligible household members even if they themselves are not eligible, and household members who are not applying do not have to give their Social Security number or immigration papers.⁸

Have an ID ready too — a driver’s license, state ID, or passport — plus something that shows Minnesota residency, such as a lease.⁸

Income

Collect pay stubs from the last 30 days for every working household member. Document any unemployment benefits, Social Security, child support, or other regular payments. Self-employed household members need federal income tax records instead of pay stubs. The form also asks about recent lump sums such as tax refunds or insurance settlements.⁸

Assets

GA and MFIP both have a $10,000 asset limit.⁹¹⁰ List checking and savings balances, stocks, and retirement accounts that could be cashed out. For MFIP, one vehicle per household member aged 16 or older is excluded; additional vehicles count.

Housing and Expenses

Pull your most recent rent or mortgage statement, property tax bill, homeowner’s insurance, and utility bills. These figures feed directly into the SNAP benefit calculation; higher shelter costs can raise the amount you receive. Also note child care costs and any court-ordered payments you are legally required to make, such as child support.

Filling Out the Form

The DHS-5223 runs 11 pages and moves in a logical order through household composition, income, assets, expenses, and the programs you want to be considered for. A fillable PDF and a printable blank are both on the DHS website.¹ If you fill it out by hand, use clear block letters; illegible answers slow processing.

Pay attention to the question about who lives in your home and whether those people buy and prepare food together. SNAP eligibility uses the “food unit,” meaning people who share meals, not just everyone at the same address. If you have a roommate who shops and cooks separately, say so. Skipped questions usually trigger a request for more information and push your decision date back.

The last page requires your signature certifying that your answers are true and correct. An unsigned form will be returned, and the processing clock does not start until the agency has a signed copy.

If you apply online at mnbenefits.mn.gov, the site walks you through the same questions and lets you upload your pay stubs, bank statements, and other verification right in the application. It estimates about 20 minutes to finish.²

How to Submit It

You can get a completed paper application to your county or Tribal Nation agency in several ways:

In person at your county or Tribal Nation human services office.
By mail to your local county human services office. Confirm the address on the county’s website or by phone.
By fax, if your county office accepts faxed applications. Call for the number.
Online at mnbenefits.mn.gov, which also lets you upload supporting documents.²

Your filing date is the date the agency receives the application, and that date drives when approved benefits start. Keep a copy of what you submit. If you mail the form, consider delivery confirmation so you have proof of arrival.

If You Are in a Financial Emergency

You may qualify for expedited SNAP, which requires the agency to issue benefits within seven calendar days of your filing date instead of 30. You qualify if any of these are true:¹¹

Your household has less than $150 in monthly countable income and $100 or less in liquid assets.
Your combined monthly income and liquid assets are less than your monthly rent or mortgage plus utility costs.
You are a destitute migrant or seasonal farmworker with $100 or less in liquid assets.

The agency is required to screen every application for expedited eligibility on the day it arrives, but mention it when you submit if you think you qualify. Apply on or before the 15th and your expedited benefits cover that month. Apply on the 16th or later and the agency issues benefits for both the application month and the following month at the same time.¹¹

What Happens After You Submit

A caseworker will contact you to schedule an eligibility interview. For SNAP this interview is required before benefits can be approved, but it can be done by phone; you do not have to go into an office.¹² During the interview, the caseworker reviews your answers, clears up anything unclear, and tells you what verification is still outstanding.

If anything is missing, you will get a written request for specific items such as bank statements, a lease, utility bills, or employer verification. Respond quickly; the clock keeps running. The agency has 30 days from your filing date to approve or deny your SNAP case, and MFIP follows the same 30-day timeline.¹³¹⁰

You will receive a written notice telling you whether you were approved or denied, your benefit amount, the start date, and how to appeal.

If You Are Denied

You can request a fair hearing if your application is denied or your benefits are reduced and you believe the decision is wrong. The hearing is handled by a human services judge, an independent decision-maker who was not involved in the original determination, and can be conducted by phone if you agree.¹⁴ Your decision notice includes instructions for filing and the deadline. If you request a hearing before your current benefits are scheduled to end, benefits generally continue at the existing level until the judge rules, so filing promptly matters even if you are confident you will win.

If you believe you were discriminated against during the application process on the basis of race, color, national origin, sex, age, disability, or other protected characteristics, you can file a complaint with the USDA within 180 days through the Program Discrimination Complaint Portal, by email to program.intake@usda.gov, or by completing USDA Form AD-3027.¹⁵

1
Minnesota Department of Human Services. Minnesota Combined Application Form
2
Minnesota Department of Children, Youth, and Families. Apply for Benefits
3
Food and Nutrition Service. What Can SNAP Buy?
4
Minnesota Department of Children, Youth, and Families. Minnesota Family Investment Program (MFIP)
5
Minnesota Office of the Revisor of Statutes. Minnesota Code 142G.90 – Diversionary Work Program
6
Minnesota Department of Human Services. GA Assistance Standards
7
Minnesota House Research Department. Minnesota Supplemental Aid
8
Minnesota Department of Human Services. Combined Application Form
9
Minnesota Department of Human Services. General Assistance
10
Disability Hub MN. Minnesota Family Investment Program (MFIP) – The Details
11
Minnesota Department of Human Services. Expedited SNAP
12
Minnesota Department of Human Services. Application Interviews
13
MNbenefits. Frequently Asked Questions
14
Minnesota Department of Human Services. Appeals
15
United States Department of Agriculture. How to File a Program Discrimination Complaint