Enter your official identification and contact details. Dshs Stop Work Form - Fill Out and Sign Printable PDF Template | signNow 2.7962 2.7525 Td /MarkInfo << Applying for MNsure Helpful Information - This document gives you step by step instructions for completing an online MNsure application. The advanced tools of the editor will direct you through the editable PDF template. If you are submitting a PDF form that contains personally identifiable information (i.e. > For all applicants give and verbally review during the interview: Give the forms below to all applicants. In the first, the county agency received a stop - work verification on 4/13. %PDF-1.5 4 0 obj It also adds appropriate cross-references. in SNAP adds in the last paragraph that unless questionable, a verbal statement from the client meets the school attendance verification requirement. << Work verification is what employers conduct to see the work history and eligibility of both current and potential employees. DHS 5576 Combined Six Month Report - This form is for people currently open on Cash, SNAP, or Healthcare that are required to complete a six month review. /OutputIntents [31 0 R] PDF Individual Electrical License Exam Application - Minnesota 0000025069 00000 n Additional State forms can be found at: Minnesota Department of Human Services Website, Documents can be submitted to the Economic Assistance Document Upload Portal Here, Instructions for using the portal can be found Here. 1300.0170 STOP WORK ORDER. 2.7962 2.7525 Td PDF Work Experience Verification Form - Minnesota Tips on how to complete the Stop working form online: To get started on the form, use the Fill camp; Sign Online button or tick the preview image of the document. 7.3425 TL {e.2J0+z0.lG%12 . H FORMS/HANDOUTS FOR APPLICANTS - dhs.state.mn.us See 0010.15 (Verification Inconsistent Information). Also see Chapter 8 (Changes in Circumstances) for verifications which may be required when a unit has a change in circumstances. If no other form of verification is available or if the client chooses to use a form to verify residence or shelter expenses, you may use the Authorization for Release of Information About Residence and Shelter Expenses (DHS-2952) (PDF). BT q EMC The verification must be in existing files. endstream endobj 416 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 434 0 obj <>/Subtype/Form/Type/XObject>>stream 0000006624 00000 n This form is for clients who have a six-month renewal for health care eligibility or a six-month report for the Supplemental Nutrition Assistance Program (SNAP) due. 5. 0.749023 g If you are not able to find the form you are looking for, search for additional forms below: Searchable document library (eDocs) / Minnesota Department of Human Services (mn.gov) Contact a human services representative Phone: 612-596-1300 M-F, 8 a.m. to 4:30 p.m. << You do not have to sign this form if either the requesting organization or the organization supplying the information is left blank. /Size 38 The participant's last day of employment was 01/13 and received the last check 1/13. << .lG%12 1300.0170 - MN Rules Part - Minnesota Residency in Minnesota, unless verification cannot be obtained because the people are homeless, migrant farmworkers, or newly arrived in Minnesota. BT Email us at compliance.mdhr@state.mn.us or call 651-539-1095. xref EMC Get the documents for Minnesota Employment verification you need with an user-interface developed for straightforwardness and organization. 0 0 9.96 9 re Employment verification Forms for Minnesota - US Legal Forms Questions about legal documents can be directed to the County Attorneys Office: 763-324-5550. See 0010.18 (Mandatory Verifications) for mandatory verifications that apply to all programs. endstream endobj 419 0 obj <>/Subtype/Form/Type/XObject>>stream ]J}5vZZc}s?W0\(+X /Tx BMC /O 4 0000021969 00000 n 0000007708 00000 n Forms | Anoka County, MN - Official Website Employment start date: . q 2 0 obj ^ey$>PzVjP~64$b*a`?H"4{p1 j X (4) Tj For more information about running SAVE, see 0010.18.11.03 (Systematic Alien Verification (SAVE)). in SNAP under sub-heading ABAWDs in the 3rd bullet adds and deletes language and cross-references for clarity. Human services e-forms. See 0017.15.36 (Student Financial Aid Income). See 0011.24 (Time-limited SNAP Recipients). DOC Hennepin County DHS-4034-ENG Minnesota's Diversionary Work Program Applications/Reporting DHS-3550-ENG Minnesota Child Care Assistance Application DHS-5223-ENG MDHS Combined Application Form DHS-2120-ENG Household Report Form DHS-3336-ENG Self-Employment Report Form DHS-2402-ENG Change Report Form Consent/Release DHS-2114-ENG MDHS Request for Medical Opinion CASES, 0022.09 - WHEN TO SWITCH BUDGET CYCLES - CASH, 0022.09.03 - WHEN TO SWITCH BUDGET CYCLES - SNAP, 0022.12 - HOW TO CALC. Follow general provisions. It also in the 4th paragraph adds tribe language. /Outlines 33 0 R in general provisions in the 2nd paragraph in the 3rd bullet adds and deletes information. Financial aid information from students attending post-secondary institutions. SERVICES SANCTIONS, 0028.30.04.03 - POST 60-MONTH SANCTIONS: 2-PARENT PROVISIONS, 0028.30.06 - SANCTIONS FOR NOT MEETING SNAP WORK RULE, 0028.30.09 - REFUSING OR TERMINATING EMPLOYMENT, 0028.30.12 - SANCTION NOTICE FOR MINOR CAREGIVER, 0028.33 - EMPLOYMENT SERVICES/SNAP E&T NOTICE REQUIREMENTS, 0029.03.06 - FAMILY SUPPORT GRANT PROGRAM, 0029.03.09 - CONSUMER SUPPORT GRANT PROGRAM, 0029.03.18 - RELATIVE CUSTODY ASSISTANCE PROGRAM, 0029.06.03 - SUPPLEMENTAL SECURITY INCOME PROGRAM, 0029.06.06 - RETIREMENT, SURVIVORS AND DISABILITY INSURANCE, 0029.06.21 - UNITED STATES REPATRIATION PROGRAM, 0029.06.24.03 - TRIBAL TANF - MILLE LACS BAND OF OJIBWE, 0029.06.24.06 - TRIBAL TANF - RED LAKE BAND OF CHIPPEWA INDIANS, 0029.07.03 - MINNESOTA STATE FOOD BENEFITS, 0029.07.09 - WOMEN, INFANTS AND CHILDREN (WIC) PROGRAM, 0029.07.12 - COMMODITY SUPPLEMENTAL FOOD PROGRAM, 0029.07.15 FOOD DISTRIBUTION PROGRAM-INDIAN RESERVATION, 0029.20.09 - FAMILY HOMELESS PREVENTION ASSISTANCE, 0029.27 - LOW INCOME HOME ENERGY ASSISTANCE PROGRAM, 0029.31 - CHILD CARE RESOURCE AND REFERRAL, 0030.03.01.01 - INELIGIBLE FOR OTHER CASH PROGRAMS, 0030.03.09 - DETERMINING RCA GROSS INCOME, 0030.03.16 - PROCESSING REPORTED CHANGES - RCA, 0030.03.18 - RCA OVERPAYMENTS AND UNDERPAYMENTS, 0030.12.03 - RCA POST-SECONDARY EDUCATION/TRAINING, 0030.12.06 - RCA EMPLOYMENT SERVICES GOOD CAUSE CLAIMS. Use the Verification Request Form (DHS-2919) (PDF) to request needed verification. Select the link to download, print or save to your computer. 0000021550 00000 n /Tx BMC Also see 0010.18.01 (Mandatory Verifications - Cash Assistance) for additional MFIP provisions relating to citizenship and immigration status. 0000001041 00000 n /Tx BMC 0000020677 00000 n in SNAP in the 2nd paragraph clarifies to allow the listed verifications only if an applicant/participant wants a deduction from their income for them. /F1 10 0 R Immigration status, ONLY if the applicant reports a non-citizen status, including non-citizens, naturalized and derived citizen status. DHS 2243 Authorization for Release of Information about Assets - This form is used to allow a bank or other financial institution to share information about your assets. Residency in Minnesota, unless verification cannot be obtained because the people are homeless, migrant farmworkers, or newly arrived in Minnesota. Fill the blank areas; involved parties names, addresses and phone numbers etc. Minnesota Department of Labor & Industry Construction Codes and Licensing Division Licensing and Certification Services 443 Lafayette Road North St. Paul, MN 55155 Mailing Address: PO Box 64217 St. Paul, MN 55164-0217 Phone: 651.284.5031 Email: dli.exam@state.mn.us Web site: www.dli.mn.gov . This program was suspended 12/1/14. n Accessibility|Privacy|Open Government| Copyright document.write(new Date().getFullYear()); Application for payment of long-term care services, Authorization to obtain or release information/records, Child care assistance program (CCAP) Change Report, Combined annual renewal for certain populations, Minnesota health care programs (MHCP) Application for certain populations, Minnesota health care programs (MHCP) Renewal for people receiving long-term care services, MNsure Application for health coverage and help paying costs. If the injury/disability is temporary, new verification will be needed if the injury/disability extends past the anticipated end date. In the first, the county agency received a stop - work verification on 4/13. DHS 3549 General Consent/Authorization for Release of Information (PDF) - This form allows you to give Economic Assistance the authority to share specific information with another person or agency. endstream endobj 410 0 obj <>/Metadata 16 0 R/Pages 407 0 R/StructTreeRoot 47 0 R/Type/Catalog/ViewerPreferences<>>> endobj 411 0 obj <>/MediaBox[0 0 612 792]/Parent 407 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 412 0 obj <>/Subtype/Form/Type/XObject>>stream 0000019279 00000 n 1) Application. BT 0.749023 g endstream endobj 425 0 obj <>/Subtype/Form/Type/XObject>>stream 0000024995 00000 n For non-mandatory verifications for SNAP, see 0010.18.02.03 (Non-Mandatory Verifications SNAP). EMC 0000024780 00000 n If the form you need is not on this list, you can visit the Minnesota Department of Human Services website where you can search eDocs to find the form you need. x]K$ 0zb%Ynl!?$(_)UkggTRHTQ?[LIt_=?I}~J@NxO?3O~CJK? 5}X}t^ x{Jk? 0000006987 00000 n Verify the following for all programs: Inconsistent information. 0000000025 00000 n AREP Authorization form for SNAP, CASH, Medical (DOC), DHS 2243 Authorization for Release of Information about Assets, DHS 2952 Authorization for Release of Information About Residence and Shelter Expenses, DHS 3549 General Consent/Authorization for Release of Information (PDF), DHS 7823 Authorization to Obtain Information from AVS, DHS-2146 Authorization for Release of Employment Information, GEN 335 General Assistance Advanced Age Form, DHS 5893 Application for Certificate of Clearance for Medical Assistance Claim - Transfer on Death Deed (PDF), DHS 6165A Application for Certificate of Clearance for Medical Assistance Claims - Decree of Descent (PDF), DHS 3543 Request for Payment of Long Term Care Services, Minnesota Department of Human Services Website, Supplemental Nutrition Assistance Program, Medical Assistance Certificate of Clearance, Medical Assistance Claim/Probate Payments. 0 0 9.96 9 re /Tx BMC The participant's last day of employment was 01/13 and received the last check 1/13. in SNAP adds a new last paragraph to not request verification of earned income of an elementary, secondary, or GED student IF the student is in school at least half-time, is under age 18, and is working. 7V,%2EPEr_:b9~*x8|s.R&"WN,I# /|!(C4YhB##v4 4kec$%:E>E7 ,)`) %bi,rKh,a% yi z.3~@m&wWs3)/Rn%p This is valid for 1 year or when I withdraw it in writing. CHECK THE BOX, sign and date on the backside. CASES, 0022.09 - WHEN TO SWITCH BUDGET CYCLES - CASH, 0022.09.03 - WHEN TO SWITCH BUDGET CYCLES - SNAP, 0022.12 - HOW TO CALC. endstream endobj 433 0 obj <>/Subtype/Form/Type/XObject>>stream See all sections of 0016 (Income from People Not in the Unit), 0017 (Determining Gross Income) for more information. 0000006411 00000 n 0000005978 00000 n GEN 260 Sponsor Release of Information - This form is used to allow Economic Assistance to communicate with the client's sponsor. Also see 0010.18.01 (Mandatory Verifications - Cash Assistance) for additional MFIP provisions relating to citizenship and immigration status. MCC Recipient Notice - Instructions for getting reimbursed for Medical Transportation, MCC Trip Log 2020-2021 - Record your trips used for Medical Appointments. Sign and date the form on or after: 6. endstream endobj 426 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream /Tx BMC MFIP/DWP employment service provider information GEN 205 Emergency Programs Release Form - This form is used to allow Economic Assistance to contact landlords and utility companies in order to complete our Emergency Assistance or Emergency General Assistance application. endstream endobj 431 0 obj <>/Subtype/Form/Type/XObject>>stream . 0.749023 g >> Verify at the point of employment termination for participants, and for any employment terminated within 60 days of application for applicants. EDAK 0058B Start and Stop Verification . Verify SNAP has closed in another state when the client has moved from another state and reports receiving SNAP in the other state. ET 0 0 9.96 8.88 re Anoka County is now accepting a variety of paperwork at two county locations and only vehicle tab renewals at two others. Work verification form (DOC) MFIP exemption - caring for a child under the age of 12 months; State. for additional MFIP provisions relating to citizenship and immigration status. 0026.30 - NOTICE, DISQUALIFICATION OF AUTHORIZED REP. 0026.33 - NOTICE, DENYING GOOD CAUSE FOR IV-D NON-COOP, 0026.39 - NOTICE OF OVERPAYMENT AND RECOUPMENT, 0026.42 - NOTICE OF INCOMPLETE OR MISSING REPORT FORM, 0026.51 - NOTICES - CHEMICAL USE ASSESSMENT, 0027.12.03 - APPEAL HEARING EXPENSE REIMBURSEMENT, 0028.03 - COUNTY AGENCY EMPL. 2.2948 3.1191 Td f This can be verified with the income verifications that are provided by the client. 0 Apply for a Workforce Certificate / Minnesota.gov for more information on counted months used in another state. DHS 3543 Request for Payment of Long Term Care Services - This form is for people currently open on Medical Assistance (MA) that need waiver services, assisted living services, or nursing home services paid. 0000001233 00000 n Hennepin County 0016 (Income from People Not in the Unit), Combined Six-Month Review (DHS-5576) (PDF), 0022.03.01.03 (Prospective Budgeting - SNAP Provisions), 0017.15.36 (Student Financial Aid Income), 0017.15.15 (Income of Minor Child/Caregiver Unde. When used, this form also meets any monthly report requirement clients may have for cash, SNAP or health care programs. endstream endobj 430 0 obj <>/Subtype/Form/Type/XObject>>stream Authorization to Release Employment Information - Minnesota: Fill out 1 1 7.96 7 re This program was suspended 12/1/14. If the exemptions are not listed below, they do not need to be verified unless questionable. 0 0 9.96 9 re 2.8541 2.7388 Td stream 0026.12.12 - WHEN NOT TO GIVE ADDITIONAL NOTICE, 0026.12.15 - WHEN TO GIVE RETROACTIVE OR NO NOTICE, 0026.12.21 - VOLUNTARY REQUEST FOR CLOSURE NOTICE, 0026.15 - NOTICE OF DENIAL, TERMINATION, OR SUSPENSION, 0026.21 - NOTICE OF CHANGE IN ISSUANCE METHOD, 0026.24 - NOTICE OF RELATIVE CONTRIBUTION. 4.9716 TL 0.749023 g Document this verbal statement in CASE/NOTEs. For more information on work rules and exemptions, see 0011.24 (Time-limited Recipients), 0028.06.12 (Who Is Exempt From SNAP Work Registration), 0028.07 (General Work Rules for SNAP). Return this form no . >> Require the client to complete only those items needed to determine eligibility or benefit for the program(s) the client is requesting or receiving. l(i`_Vh5F,mXB7sJK~A."ak&MaWtyB\"#upI7HD6 .Qpfv \#ba=Jzc0%FFA(=Z(pK4V:pT"#nQ $F_Mq~$\b7 .QpQ $FF#Lzup! Unit Member Information. EMC MSA, GA, GRH: Q CC0100 Plumbing Work Experience Form. QD~bJmb}`!lsUJ3>11g.x z;eY#\. Stop Work Form Hennepin County - Fill and Sign Printable Template Online ET /T 0000025941 Forms | Twin Cities One Stop Student Services - University of Minnesota See 0007.03 (Monthly Reporting - Cash), 0007.03.02 (Six-Month Reporting), 0007.15 (Unscheduled Reporting of Changes - Cash), 0007.15.03 (Unscheduled Reporting of Changes - SNAP), 0009 (Recertification). hbbd```b``"wH`j endstream endobj 432 0 obj <>/Subtype/Form/Type/XObject>>stream /Parent 1 0 R 0000001409 00000 n CF 1042 (11-14) Title: HENNEPIN COUNTY Subject ( Author: Shari Sellner Last modified by: Anne C . 0026.12.12 - WHEN NOT TO GIVE ADDITIONAL NOTICE, 0026.12.15 - WHEN TO GIVE RETROACTIVE OR NO NOTICE, 0026.12.21 - VOLUNTARY REQUEST FOR CLOSURE NOTICE, 0026.15 - NOTICE OF DENIAL, TERMINATION, OR SUSPENSION, 0026.21 - NOTICE OF CHANGE IN ISSUANCE METHOD, 0026.24 - NOTICE OF RELATIVE CONTRIBUTION. 0010.18.02.03 (Non-Mandatory Verifications SNAP), 0010.15 (Verification Inconsistent Information), 0010.18.06 (Verifying Disability/Incapacity SNAP), 0010.18.02 - MANDATORY VERIFICATIONS - SNAP. /ZaDb 5.1626 Tf Choose My Signature. There are many types and sources of income that need to be considered and verified for the SNAP assistance unit including, but not limited to, ineligible mandatory unit members, sponsors income and income from people not in the unit. @~bJmmv6. X^'=sAb7:7f]l}`d1f7eB\w w= endstream endobj 423 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream Stop Work Verification accap.org Details File Format PDF Size: 358 KB Download What Is a Work Verification Form? EMC US Legal Forms is definitely the industry leader in affordable access to state-specific form templates. Q 4.9716 TL If you are not able to find the form you are looking for, search for additional forms below: Searchable document library (eDocs) / Minnesota Department of Human Services (mn.gov). 3 0 obj in SNAP deletes to verify disability exemption from work registration. Find the Stop Work Form Hennepin County you require. /F6 14 0 R f PDF PRINT IN INK OR TYPE Electrical MAKE A COPY OF THIS FORM - Minnesota GEN 280 Drug Felony Release form - This form is used to allow Economic Assistance to obtain information regarding drug test results. /Metadata 34 0 R endobj To learn more about what might be personally identifiable information . endstream endobj 437 0 obj <>/Subtype/Form/Type/XObject>>stream Please seek professional legal advice if you are not sure this is the correct form for your situation. (4) Tj /ZaDb 5.0258 Tf DHS-2146 Authorization for Release of Employment Information - This form is completed by an employer to verify employment start, stop, or wage change. The locations accepting paperwork including vehicle tab renewals, property tax documents, child support and economic assistance applications, and reporting forms are: Paperwork that CANNOT be accepted at drop boxes are documents related to legal service, litigation, or court matters. 0000019304 00000 n Please seek professional legal advice if you are not sure this is the correct form for your situation. The verification requirements are as follows: 03. AE>-l`.X~JpRMcOxr69_vW61# U3U]30 n0 STOP HERE. DHS 2952-ENG Authorization for Release of Information about Residence and Shelter ExpenseAuthorization form allowing release of residence and shelter expense information required for the determination of eligibility for human service programs. 1. See 0010.15 (Verification - Inconsistent Information). If there is student income, also give the Financial Aid Information Form (DHS-2646) (PDF). endobj Termination of Employment Verification - Section 8/236 Rev. PDF DHS-2120-ENG 9-17 Household Report Form - 83rd Minnesota Legislature breaks MFIP, DWP into their own provisions and adds when not to request verification of school attendance. H BT /ZaDb 5.1626 Tf /Tx BMC f 0000022117 00000 n in SNAP adds that identity may be verified through a document, collateral contact or SOLQ-I. 0000006779 00000 n Verify additional eligibility factors required by each program as noted in the specific program provisions in 0004.12 (Verification Requirements for Emergency Aid), 0010.18.01 (Mandatory Verifications - Cash Assistance), 0010.18.02 (Mandatory Verifications - SNAP). Case Name: Case Number: 15. ET endstream endobj 413 0 obj <>/Subtype/Form/Type/XObject>>stream 0000019329 00000 n It can also be used but is not required for collecting information on people added to the Supplemental Nutrition Assistance Program (SNAP) or a Minnesota health care program. endstream endobj 415 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream There are three variants; a typed, drawn or uploaded signature. Verify eligibility factors at initial application. endstream endobj 441 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream The participant's last day of employment was 01/13 and received the last check 1/13. 1 1 7.96 6.88 re 2023 Minnesota Department of Human Services, 0010.18.03 (Verifying Social Security Numbers), 0010.18.11.03 (Systematic Alien Verification (SAVE)), 0010.18.11 (Verifying Citizenship and Immigration Status), 0011.03.27 (Undocumented and Non-Immigrant People). The stop work order shall be in writing and issued to the owner of the property . endstream endobj 429 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream 2) Affirmative Action Plan. f'G!&MCa a@e9\$!E!@m`R`IF\n@ @ @3Nd&` ` xP July 2, 2019 General Phone 651-554-5611 . EMC Some Spanish forms are also available. 0.749023 g /E 0000027097 0000021573 00000 n This information can be obtained from the client's Employment Services Provider. 0000025750 00000 n (4) Tj n SNAP: PARENT/GUARD. When used, this form also meets any monthly report requirement clients may have for cash, SNAP or health care programs. FREE 13+ Work Verification Forms in PDF | Ms Word - sampleforms 37 0 obj /Tx BMC /Tx BMC 0000001524 00000 n Share your form with others Send it via email, link, or fax. endstream endobj 417 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream Do not run a Systematic Alien Verifications for Entitlements (SAVE) report unless you have determined that the applicant meets all other program requirements and the client would be eligible for benefits if the immigration status requirement is met. % GEN 262 Special Diets - This form is used to provide information regarding diets prescribed by a doctor. DHS 3336-ENG Self-Employment Report FormReport used by participants who are self-employed to report income and expenses each month. Go to the Department of Human Services' (DHS) e-Docs site and search for the form by entering the DHS form number. /Tx BMC for additional MFIP provisions relating to citizenship and immigration status. Put the particular date and place your e-signature. BENEFIT LEVEL - MFIP/DWP/GA, 0022.12.01 - HOW TO CALCULATE BENEFIT LEVEL - SNAP/MSA/GRH, 0022.12.02 - BEGINNING DATE OF ELIGIBILITY, 0022.15.03 - BUDGETING LUMP SUMS IN A PROSPECTIVE MONTH, 0022.15.06 - BUDGETING LUMP SUMS IN A RETROSPECTIVE MONTH, 0022.18.03 - OVERPAYMENTS RELATING TO SUSPENDED CASES, 0022.21 - INCOME OVERPAYMENT RELATING TO BUDGET CYCLE, 0022.24 - UNCLE HARRY FOOD SUPPORT BENEFITS, 0023.09 - HOUSEHOLD FURNISHINGS AND APPLIANCES, 0024.03 - WHEN BENEFITS ARE PAID - MFIP/DWP, 0024.03.03 - WHEN BENEFITS ARE PAID - SNAP/MSA/GA/GRH, 0024.04.03.03 - BENEFIT DELIVERY METHODS--PROGRAM PROVISIONS, 0024.04.04 - CHANGES IN AUTOMATIC BENEFIT DELIVERY METHOD, 0024.06 - PROVISIONS FOR REPLACING BENEFITS, 0024.06.03 - SITUATIONS REQUIRING SNAP BENEFIT REPLACEMENT, 0024.06.03.03 - REPLACING SNAP STOLEN/LOST BEFORE RECEIPT, 0024.06.03.15 - REPLACING FOOD DESTROYED IN A DISASTER, 0024.06.03.18 - REPLACING DAMAGED SNAP CASH-OUT WARRANTS, 0024.09.01 - PROTECTIVE AND VENDOR PAYMENTS-SNAP/MSA/GA/GRH, 0024.09.09 - DISCONTINUING PROTECTIVE AND VENDOR PAYMENTS, 0024.09.12 - PAYMENTS AFTER CHEMICAL USE ASSESSMENT, 0024.12 - ISSUING AND REPLACING IDENTIFICATION CARDS, 0025.03 - DETERMINING INCORRECT PAYMENT AMOUNTS, 0025.06 - MAINTAINING RECORDS OF INCORRECT PAYMENTS, 0025.09.03 - WHERE TO SEND CORRECTIVE PAYMENTS, 0025.12.03 - OVERPAYMENTS EXEMPT FROM RECOVERY, 0025.12.03.03 - SUSPENDING OR TERMINATING RECOVERY, 0025.12.03.09 - CLAIM COMPROMISE & TERMINATION, 0025.12.06 - REPAYING OVERPAYMENTS - PARTICIPANTS, 0025.12.09 - REPAYING OVERPAYMENTS - NON-PARTICIPANTS, 0025.12.12 - ACTION ON OVERPAYMENTS - TIME LIMITS, 0025.15 - ORDER OF RECOVERY - PARTICIPANTS, 0025.18 - ORDER OF RECOVERY - NON-PARTICIPANTS, 0025.21.03 - OVERPAYMENT REPAYMENT AGREEMENT, 0025.24 - FRAUDULENTLY OBTAINING PUBLIC ASSISTANCE, 0025.24.03 - RECOVERING FRAUDULENTLY OBTAINED ASSISTANCE, 0025.24.06.03 - ADMINISTRATIVE DISQUALIFICATION HEARING, 0025.24.07 - DISQUALIFICATION FOR ILLEGAL USE OF SNAP, 0025.24.08 - SNAP ELECTRONIC DISQUALIFIED RECIPIENT SYSTEM, 0025.30 - FINANCIAL RESPONSIBILITY, PEOPLE NOT IN HOME, 0025.30.03 - CONTRIBUTIONS FROM PARENTS NOT IN HOME. /F4 12 0 R endstream endobj 438 0 obj <>/Subtype/Form/Type/XObject>>stream 0026.30 - NOTICE, DISQUALIFICATION OF AUTHORIZED REP. 0026.33 - NOTICE, DENYING GOOD CAUSE FOR IV-D NON-COOP, 0026.39 - NOTICE OF OVERPAYMENT AND RECOUPMENT, 0026.42 - NOTICE OF INCOMPLETE OR MISSING REPORT FORM, 0026.51 - NOTICES - CHEMICAL USE ASSESSMENT, 0027.12.03 - APPEAL HEARING EXPENSE REIMBURSEMENT, 0028.03 - COUNTY AGENCY EMPL. DHS 8107 Household Update Form - This form is for people currently open on Cash or SNAP programs that need to complete a review following the COVID emergency. 0 0 Td W endstream 557 0 obj <>stream EDAK 3670 Consent for Release Regarding Utility Shutoffs And/Or EvictionAuthorization form allowing Dakota County Employment & Economic Assistance permission to contact utility companies and/or landlord for information required for determination of eligibility for assistance.

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