DHS Household Report Form Instructions
The DHS Household Report Form is essential for updating your household information and ensuring continued benefits. This form must be filled out accurately and returned in a timely manner. Follow the provided guidelines to avoid delays or interruptions in your public assistance.
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How do I fill this out?
Filling out the DHS Household Report Form is a straightforward process. Carefully read each question and provide accurate information. If you're uncertain about any section, refer to the guidelines provided or seek assistance.

How to fill out the DHS Household Report Form Instructions?
1
Start with entering your case number and report month.
2
Answer all questions with 'Yes' or 'No', and provide additional details where necessary.
3
If required, attach extra pages to provide complete answers.
4
Sign and date the form once you've completed it.
5
Submit the form by the specified due date to avoid delays.
Who needs the DHS Household Report Form Instructions?
1
Individuals receiving public assistance who need to report changes.
2
Families applying for food or cash benefits to update their details.
3
New residents in Minnesota needing assistance to obtain benefits.
4
Caregivers looking to report unearned or earned income for relief programs.
5
Students applying for benefits based on their financial situation.
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Use the editing tools to fill in all required fields.
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Review your answers and make corrections if necessary.
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What are the instructions for submitting this form?
Submit the completed DHS Household Report Form either by mailing it to the appropriate county office or via fax. If preferred, you can also submit it online through the Minnesota Department of Human Services website. Ensure that you follow the instructions on the form for timely submission, including providing the correct address, fax number, and any necessary documentation.
What are the important dates for this form in 2024 and 2025?
Important deadlines for submitting the DHS Household Report Form may vary each year, so it's essential to stay updated. For 2024, ensure your submissions are made by the specified due dates to prevent any lapses in benefits. In 2025, keep an eye out for similar deadlines to maintain compliance.

What is the purpose of this form?
The DHS Household Report Form serves to update the Minnesota Department of Human Services about changes in household circumstances. It is vital for ensuring that individuals and families continue to receive the appropriate level of assistance. By reporting changes promptly, applicants can avoid unnecessary delays or interruptions in their benefits.

Tell me about this form and its components and fields line-by-line.

- 1. Case Number: Unique identifier for your assistance case.
- 2. Report Month: The month for which you are reporting.
- 3. Address Change: To report any recent moves or changes in residence.
- 4. Household Members: Details of individuals moving in or out of your household.
- 5. Income Types: To report sources of earned and unearned income.
- 6. Assets: Assessment of your total asset value.
- 7. Care Expenses: For reporting costs related to child or adult care.
What happens if I fail to submit this form?
If you fail to submit the DHS Household Report Form, your benefits may be delayed or discontinued. It's vital to stay compliant with the reporting requirement to ensure continued access to assistance. Always follow up to confirm that your form was received.
- Benefit Delays: A late submission can result in waiting periods for receiving benefits.
- Potential Suspension: Failure to submit may cause an immediate suspension of your benefits.
- Need for Resubmission: You may need to submit your information again, causing further delays.
How do I know when to use this form?

- 1. Change in Income: Report any changes in your income sources or amounts.
- 2. New Household Members: To document anyone moving in or out of your residence.
- 3. Change of Address: Use this form to inform the department of your new address.
Frequently Asked Questions
What is the DHS Household Report Form?
It is a form required for reporting your household circumstances to the Minnesota Department of Human Services.
Who needs to fill out this form?
Any participant in Minnesota's public assistance programs must complete this form to keep their benefits active.
What information is required on the form?
You will need to provide details related to your household, income, and any changes that occurred during the report month.
How can I edit my DHS Household Report Form?
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What should I do if I make a mistake?
You can easily correct any errors using the editing features before saving your document.
Can I submit this form electronically?
Yes, once you have filled out and signed the form, you can submit it through the methods listed in our guidelines.
How do I ensure my information is accurate?
Review each section carefully and double-check all figures and details before submission.
Where should I send my completed form?
Refer to the submission instructions to find the correct mailing or fax number.
What happens if I don’t submit the form on time?
Delays in submission can lead to interruptions in your benefits, so it’s important to send it promptly.
Can I save my edits in PrintFriendly?
You can download your edited document, but saving directly on PrintFriendly is not currently available.
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