Overview
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Application for Certain Benefits and Services
Common application for Public Assistance, Child Care in Lieu of Public Assistance, the Supplemental Nutrition Assistance Program (SNAP), Medicaid and SNAP, Medicaid and Public Assistance, Services included Foster Care, Child Care Assistance, and Emergency Assistance only.
- Application for Certain Benefits and Services (LDSS-2921)
- Instructions for Completing the Application for Certain Benefits and Services (PUB-1301)
Recertification Form for Certain Benefits and Services
Recertification form for Public Assistance, Supplemental Nutrition Assistance Program (SNAP), Medicaid and SNAP, and Medicaid and Public Assistance.
- Recertification Form for Certain Benefits and Services (LDSS-3174)
- Instructions for Completing the Recertification for Certain Benefits and Services Form (PUB-1313)
Supplemental Nutrition Assistance Program (SNAP) Benefits
- SNAP Application/Recertification (LDSS-4826)
- Instructions for Completing the SNAP Application/Recertification (LDSS-4826A)
- Request for Replacement of Food Purchased with Supplemental Nutrition Assistance Program (SNAP) Benefits (English/Spanish) (LDSS-2291)
- Supplemental Nutrition Assistance Program (SNAP) Authorized Representative Request Form (LDSS-4942)
- Supplemental Nutrition Assistance Program (SNAP) Change Report Form (LDSS-3151)
- Application/Recertification for Supplemental Nutrition Assistance Program (SNAP) Benefits (LDSS-5166)
SCAM Alert
Scammers offer phony SNAP application assistance
Summer EBT
Most families do NOT need to apply for Summer EBT and will be issued benefits automatically. For those who do need to apply, Summer EBT applications should be submitted using the online application, on the Summer EBT webpage whenever possible. If you are unable to apply online, you can apply using the below application. This form must be downloaded, printed, completed, and mailed to the address listed on the top of the application. The deadline to mail a completed application is September 4, 2025.
Home Energy Assistance Program (HEAP)
The HEAP application is available when HEAP is open.
- Home Energy Assistance Program (HEAP) Application (LDSS-3421)
- LDSS-3421 - Arabic, LDSS-3421 - Bengali, LDSS-3421 - Chinese, LDSS-3421 - French, LDSS-3421 - Haitian Creole, LDSS-3421 - Italian, LDSS-3421 - Korean, LDSS-3421 - Polish, LDSS-3421 - Russian, LDSS-3421 - Spanish, LDSS-3421 - Urdu, LDSS-3421 - Yiddish
- Qualified Alien Definition (LDSS-4998)
State Supplement Program (SSP)
- Living Arrangement Form (LDSS-5030)
- Direct Deposit Enrollment Form for SSP Recipients (LDSS-5025)
- Direct Deposit Cancellation Form for SSP Recipients (LDSS-5067)
- SSP Income Verification Form (LDSS-5040)
- Designated Representative Form (LDSS-5024)
- Congregate Care Change Report Form (LDSS-5023)
Child Support Services
- Acknowledgment of Parentage (LDSS-5171)
- Child Support Enrollment Form (LDSS-5258)
- Important Information about Child Support Services (LDSS-5258A)
- Getting Child Support Safely: What You Should Know (Flyer) (LDSS-5228)
- Family Safety Screening Form (LDSS-5291)
Temporary Assistance for Needy Families (TANF)
Application Booklets
Information on your rights and responsibilities, and the services and programs available to you.
- What You Should Know About Your Rights and Responsibilities (LDSS-4148A)
- What You Should Know About Social Services Programs (LDSS-4148B)
- Insert for LDSS-4148B, What you Should Know About Social Services Programs (LDSS-4148B.1)
- Important Changes in the Medicaid Program (Supplement to LDSS-4148A and LDSS-4148B)
- LDSS-4148A and LDSS-4148B Supplement - Arabic, LDSS-4148A and LDSS-4148B Supplement - Bengali, LDSS-4148A and LDSS-4148B Supplement - Chinese, LDSS-4148A and LDSS-4148B Supplement - French, LDSS-4148A and LDSS-4148B Supplement - Haitian Creole, LDSS-4148A and LDSS-4148B Supplement - Italian, LDSS-4148A and LDSS-4148B Supplement - Korean, LDSS-4148A and LDSS-4148B Supplement - Polish, LDSS-4148A and LDSS-4148B Supplement - Russian, LDSS-4148A and LDSS-4148B Supplement - Spanish, LDSS-4148A and LDSS-4148B Supplement - Urdu, LDSS-4148A and LDSS-4148B Supplement - Yiddish
- What You Should Know If You Have an Emergency (LDSS-4148C)
- Accessing Applicant/Recipient Informational Books (LDSS-5084)
What are my Rights?
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