Get Redetermination Form Dhs 5274 - Anoka County Community Action ...

The Redetermination Form DHS 5274 is essential for individuals seeking continued assistance with child care expenses through the Minnesota Child Care Assistance Program. This guide will provide detailed instructions on completing the form online, ensuring that you understand each section and field required for a successful submission.

Follow the steps to complete your Redetermination Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Provide your personal information, including your name, phone number, case number, and address. Ensure that this information is accurate, as it will be used for further communication.
3. List all household members living in your home. Include their names, relationships to you, birth dates, and any relevant race and ethnicity information, following the instructions provided.
4. Detail your income and that of all family members living with you. Indicate if anyone is employed or self-employed and provide the necessary income documentation as required.
5. Report any household expenses such as medical insurance or child support payments, ensuring you attach proof of these expenses.
6. Provide information on family members attending school, outlining their schedules and the schools they attend or plan to attend.
7. Indicate the child care needs for each child, including the provider's details and the hours/days when care is needed.
8. Review the consent section regarding the sharing of information. Make sure you understand this before you sign and date the form.
9. After completing all required sections, carefully read through the 'Penalty warning,' 'Your responsibilities,' and 'Your rights' sections.
10. Submit the completed form by mailing, faxing, or delivering it to your child care worker, ensuring that you attach all necessary documentation.
11. Finally, make sure to save any changes, download a copy of the form for your records, or print it before submission.

Complete your Redetermination Form DHS 5274 online today to ensure you continue receiving child care assistance.