Hennepin Minnesota Wage and Income Loss Statement

State:
Multi-State
County:
Hennepin
Control #:
US-PI-0009
Format:
Word; 
Rich Text
Instant download

Description

This form is intended to assist the attorney in case preparation by providing the client with a form to be used in documenting all expenses and lost wages associated with the client's claim.
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FAQ

To receive PCA services, you must: Enroll with Medical Assistance (MA), MinnesotaCare expanded benefits, Alternative Care Program or a waiver program. Request a PCA assessment from your local county agency or tribe or your health plan member services to see if you eligible to receive PCA services.

Call the Hennepin County Human Services Navigator phone line at 612-543-5500.

If you have questions about making a referral please contact the Targeted and Intensive Case Management programs at info@touchstonemh.org or by phone at (612) 874-6409. If you are not a service provider and you need help in finding mental health services please contact Hennepin County.

Applications for SNAP benefits are available at any Social Security office. If you and everyone in your household are applying for or already getting SSI payments, any Social Security office will help you fill out the SNAP application and send it to the SNAP office for you.

The best option for submitting documents and information is online through your InfoKeep account or MNBenefits. You can also send your documents to our virtual drop box, or fax or mail them. If you don't have access to these options, there are document drop boxes available at any Human Service Center.

Minnesota became the 20th state in the nation to raise the gross income threshold for the Supplemental Nutrition Assistance Program (SNAP, formally known as food stamps) to 200% of the federal poverty level....SNAP Income Limit Increases to 200% in Fall of 2022. Household sizeIncome Limit3$3,8384$4,6255$5,4126$6,1987 more rows ?

Call 612-348-3000, Monday through Friday, 8 a.m. to p.m.

Human services directory Adoption. Services for children waiting to be adopted and prospective families. Adult protection.Burial assistance.Cash assistance.Chemical addiction treatment.Child and Teen Checkups.Child care assistance.Child protection services.

MFIP/DWP ASSISTANCE STANDARDS FAMILY WAGE LEVEL------------------------------TRANSITIONAL STANDARD----------------------# Eligible PeopleCash Portion1$677$3802$1,115$5833$1,436$6869 more rows ?

Fill out an application To apply for assistance, fill out an online application or print the combined application form and mail it back to the address below. You may also call 612-596-1300 to have a form mailed to you. Get a translated form from DHS. You can mail the form to P.O. Box 107, Minneapolis, MN 55440.

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Hennepin Minnesota Wage and Income Loss Statement