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
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 - Haitian Creole, LDSS-3421 - Italian, LDSS-3421 - Korean, LDSS-3421 - Polish, LDSS-3421 - Russian, LDSS-3421 - Spanish, 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)
- Income Verification Form (LDSS-5040)
- Designated Representative Form (LDSS-5024)
- Congregate Care Change Report Form (LDSS-5023)
Child Support Services
- Application for Child Support Services (LDSS-5143)
- Information about Child Support Services (LDSS-5143A)
- Additional Child Information (Application) (LDSS-5143B)
- Acknowledgment of Parentage (LDSS-5171)
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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