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Common Forms and Applications

Common Application

Common Application for Temporary Assistance, Medical Assistance, Supplemental Nutrition Assistance Program (SNAP), and Services including Foster Care and Child Care Assistance

• Common Application (LDSS-2921)
  • LDSS-2921 Arabic, LDSS-2921 Chinese, LDSS-2921 Haitian/Creole, LDSS-2921 Italian, LDSS-2921 Russian, LDSS-2921 Spanish
• How To Complete The Common Application (LDSS-1301)
  • LDSS-1301 Arabic, LDSS-1301 Chinese, LDSS-1301 Haitian/Creole, LDSS-1301 Italian, LDSS-1301 Russian, LDSS-1301 Spanish

Recertification Form

Recertification Form for Temporary Assistance, Medical Assistance, Medicare Savings Program, and Supplemental Nutrition Assistance Program (SNAP)

• Recertification Form (LDSS-3174)
  • LDSS-3174 Arabic, LDSS-3174 Chinese, LDSS-3174 Haitian/Creole, LDSS-3174 Russian, LDSS-3174 Spanish
• How To Complete The Recertification Form (LDSS-1313)
  • LDSS-1313 Arabic, LDSS-1313 Chinese, LDSS-1313 Haitian/Creole, LDSS-1313 Russian, LDSS-1313 Spanish

Home Energy Assistance Program (HEAP)

Applications for regular HEAP benefits will be accepted beginning November 19, 2012.

• Qualified Alien Definition
• Documentation Requirements

Supplemental Nutrition Assistance Program (SNAP) Benefits

Application/Recertification, Instructions for Completion, Request for Replacement of Food Purchased with SNAP Benefits - SNAP is the new name for the Food Stamp Program

• SNAP Benefits Application/Recertification (LDSS-4826)
  • LDSS-4826 - Arabic, LDSS-4826 - Chinese, LDSS-4826 - Haitian/Creole, LDSS-4826 - Korean, LDSS-4826 - Russian, LDSS-4826 - Spanish
• How To Complete The SNAP Benefits Application/Recertification (LDSS-4826A)
  • LDSS-4826A - Arabic, LDSS-4826A - Chinese, LDSS-4826A - Haitian/Creole, LDSS-4826A - Korean, LDSS-4826A - Russian, LDSS-4826A - Spanish
• Supplemental Nutrition Assistance Program (SNAP) Authorized Representative Request Form (LDSS-4942)
  • LDSS-4942 - Spanish
• NYC - Request for Replacement of Food Purchased with Supplemental Nutrition Assistance Program (SNAP) Benefits (English) (LDSS-2291A NYC)
  • Arabic 2291A-AR NYC, Chinese 2291A-CH NYC, Haitian-Creole 2291A-HA NYC, Korean 2291A-KO NYC, Russian 2291A-RU NYC, Spanish 2291A-SP NYC
• Request for Replacement of Food Purchased with Supplemental Nutrition Assistance Program (SNAP) Benefits (English/Spanish) (LDSS-2291)
  • LDSS-2291 - Arabic, LDSS-2291 - Chinese, LDSS-2291 - Haitian/Creole, LDSS-2291 - Italian, LDSS-2291 - Korean, LDSS-2291 - Russian

SCAM Alert

Scammers offer phony SNAP application assistance

Child Support Services

• Application for Child Support Services (LDSS-4882)
• Information about Child Support Services (LDSS-4882A)
• Information for an Additional Noncustodial Parent (NCP)/Putative Father (PF) (LDSS-4882B)
• Information for an Additional Child (LDSS-4882C)

Temporary Assistance for Needy Families (TANF)

• TANF Services Certification (LDSS-4726)
  • LDSS-4726 - Spanish
• Youth Application for TANF Services (LDSS-4770)
  • LDSS-4770 - Spanish

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)
  • LDSS-4148A Arabic, LDSS-4148A Chinese, LDSS-4148A French, LDSS-4148A Haitian-Creole, LDSS-4148A Italian, LDSS-4148A Korean, LDSS-4148A Russian, LDSS-4148A Spanish, LDSS-4148A Vietnamese, LDSS-4148A Yiddish
• What You Should Know About Social Services Programs (LDSS-4148B)
  • LDSS-4148B Arabic, LDSS-4148B Chinese, LDSS-4148B French, LDSS-4148B Haitian-Creole, LDSS-4148B Italian, LDSS-4148B Korean, LDSS-4148B Russian, LDSS-4148B Spanish, LDSS-4148B Vietnamese, LDSS-4148B Yiddish
• Important Changes in the Medicaid Program - Supplement to LDSS-4148A and LDS-4148B
• What You Should Know If You Have An Emergency (LDSS-4148C)
  • LDSS-4148C Arabic, LDSS-4148C Chinese, LDSS-4148C French, LDSS-4148C Haitian-Creole, LDSS-4148C Italian, LDSS-4148C Korean, LDSS-4148C Russian, LDSS-4148C Spanish, LDSS-4148C Vietnamese, LDSS-4148C Yiddish

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