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Common Forms and Applications
Common Application
Common Application for Temporary Assistance, Medical Assistance, Food Stamp Benefits, and Services including Foster Care and Child Care Assistance
Recertification Form
Recertification Form for Temporary Assistance, Medical Assistance, Medicare Savings Program, and Food Stamp Benefits
Home Energy Assistance Program (HEAP)
The HEAP program closed on Friday, April 13, 2012.
- Home Energy Assistance Program Application and Instructions (LDSS-3421)
- LDSS-3421 Spanish
- Qualified Alien Definition
- Documentation Requirements
Food Stamps Benefits
Application, Instructions for Completion, Request for Replacement of Food Purchased with Food Stamps
- Food Stamp Benefits Application (LDSS-4826)
- How To Complete The Food Stamp Benefits Application (LDSS-4826A)
- Food Stamp Program Authorized Representative Request Form (LDSS-4942)
- Request for Replacement of Food Purchased with Food Stamps Benefits (LDSS-2291)
Child Support Services
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)
- What You Should Know If You Have An Emergency (LDSS-4148C)
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