OTDA Fax Services Unavailable Sunday, February 19, 2017

Due to scheduled maintenance the Office of Temporary and Disability Assistance's fax services are not available Sunday, February 19, 2017. Service is expected to resume Monday, February 20, 2017.

Last updated: February 17, 2017, 4:15 PM

Alternative Format Forms

OTDA Home Programs Forms Alternative Format Forms

Alternative Format Forms

If you are blind or visually impaired — you have choices on how you receive information.

You can choose to download the forms listed below or you can contact your local department of social services to request the forms listed below. Forms are available in the following formats.

  • Audio Disc (AD) – an audio transcription of the form,
  • Data Disc (DD) – a screen reader accessible form,
  • Large Print (LP), and
  • Braille (BR). (Not available online – to order please write or call your local department of social services)

To order alternative format applications please write or call your local department of social services.

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.

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.

Supplemental Nutrition Assistance Program (SNAP) Benefits

Home Energy Assistance Program (HEAP)

Application Booklets

Information on your rights and responsibilities, and the services and programs available to you.

This page contains links to PDF documents. Download Acrobat Reader to view these documents.

Back to Top