Minnesota Department of Human Services


Benefit Verifications on Former Minnesota Clients

(For requests of SNAP and TANF programs only)

                                                                                                          
Fields denoted with an asterisk(*) are required for submission

Today's Date: Apr 27, 2017
First Name: * Last Name: *
Your Government Agency's name: * Your State: *
Your County: Your Govt Agency Phone Number: *
Your Govt Agency Issued Email address: * Code: *

Warning and Oath for DHS Benefit Verification System

Warning

This system is the property of the Minnesota Department of Human Services (DHS). Use of this system without authority from DHS, or in excess of that authority, may result in the following: disciplinary action, including suspension without pay or dismissal; civil liability, including payment of damages, costs, and the reasonable attorney’s fees of the victim; and possible criminal penalties for willful violations.

Any activity on this system may be monitored or accessed by DHS or other authorized officials at any time. This includes any data created or stored using this system. All such data is subject to the Minnesota Government Data Practices Act. Any identified evidence of possible criminal activity will be provided to appropriate law enforcement agencies.

Oath

By continuing to use this system, I am representing myself as an authorized requester from another state agency that is accessing this system to help in determining eligibility for federal SNAP or TANF programs. I understand that I am only permitted to use the data received from this system as required in my job and I will access, use, or disclose the data only as required to perform the duties of my job. I understand that the use of this data is regulated by the Minnesota Government Data Practices Act and the misuse of information received from this system could result in civil and criminal penalties.

       * Not accepting the oath will cancel the request