The DHS-3469 (Exhibit I) is the form, which obtains detailed information used to evaluate
eligibility for the benefits covered by the application. Field offices should make
sure they are using the most current version of the state Combined Application Form,
since it is updated periodically. The current version can be accessed at: http://edocs.dhs.state.mn.us/lfserver/Legacy/DHS-3469-ENG SSA interviewers should complete only the yellow/white portions on the DHS-3469.
Most questions on the CAF are self-explanatory and require "Yes" or "No" answers.
If the applicant does not know the answer to a question, enter a question mark (?)
to let the food support worker know further development is needed.
The CAF can only be completed by and/or for households eligible to file for food support
at a SSA office under joint processing procedures (SI 01801.005). If a member of the public who is not eligible to file for food support in a SSA
office (e.g., not a member of a pure SSI household) indicates a desire to file for
food support, the individual should be referred to the local county social services