Important Message for Recipients Receiving SSP Benefits - April Payment Date Change for Direct Deposit

State Supplement Program (SSP) benefit direct deposit payments for April 2017 will be directly deposited on March 27, 2017. Paper checks are scheduled to arrive on or about March 31, 2017. This direct deposit payment schedule change is necessary to complete State Fiscal Year 2016-2017 closeout activities. This does not change the payment schedule for federal Supplemental Security Income (SSI) or any other benefits issued by the U.S. Social Security Administration. Please call the SSP Customer Support Center at 1-855-488-0541 between 8:30 am and 4:45 pm Monday through Friday if you have any questions.

Mensaje Importante para los Beneficiarios de Subsidios SSP – Cambio de Fecha del Pago de Abril de Depósito Directo

Last updated: March 17, 2017 at 10:00 AM

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)

The HEAP application is available when HEAP is open.

  • Home Energy Assistance Program (HEAP) Application (LDSS-3421)
    • LDSS-3421 AD
    • LDSS-3421 DD
    • LDSS-3421 LP
    • LDSS-3421 BR (Not available online.)

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.

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