DWSS-Applications & Forms

Child Care
 
TITLE
FORM    UPDATED
Parental Reimbursement Worksheet 2028-EE  05/24/2017
Application for Child Care Assistance 2151-WC  09/30/2015
Solicitud de Asistencia de Cuidado de Niños 2151-WCS 01/01/2016

Food (SNAP)  
 
TITLE   FORM   UPDATED
Statement of Applicant/Recipient Designating Burial Funds   2006-EG 05/24/2017
SNAP Affidavit of Separate Household 2008-EF  05/24/2017
Income from Farm Operations & Other Self-Employment Operation Worksheet 2011A  05/24/2017
Self-Employment Worksheet 2011-EG 05/24/2017
Insurance Policy Worksheet 2015-EG 05/24/2017
Banking/Loan Activity - Request for Information 2016-EG 05/24/2017
Financial Aid 2020-EF  05/24/2017
Public Law Certification 2022-EM 05/24/2017
VA Benefit Inquiry 2038-EE  05/24/2017
Parental Reimbursement Questionnaire 2069-EM 05/24/2017
Employer Payroll Statement 2074-EG-B 05/24/2017
Self-Employed/Tip Statement 2120-EG 05/24/2017
Interface Consent 2179-EE  05/24/2017
Voluntary Reduction, Withdrawal or Termination of Assistance 2248-EG 05/24/2017
Conference/Hearings 2254-EE  05/24/2017
Child Care Expense Verification Form 2329-EE  05/24/2017
Benefit Verification Inquiry 2339-EG 05/24/2017
Insufficient Information 2429-EEA  05/24/2017
Authorization for Release of Information 2451-EE  05/24/2017
Rent/Household Composition 2488-EG 05/24/2017
Cash Contribution Verification 2506-EG 05/24/2017
 Information Needed to Process Your Application   2522-EE  05/24/2017
Información Necesaria Para Procesar Su Solicitud 2522-EES  11/12/2014
Medical Facility Information 2547-EG 05/24/2017
 Change Report Form   2584-EG 05/24/2017
Forma para Reportar Cambios 2584-EGS  05/27/2016
Transfer/Disposal of Asset Notification 2601B  05/24/2017
Joint Ownership of Bank Account 2614-EE  05/24/2017
Assessment and Documentation of Resources 2793-EM 05/24/2017
Request for a Resource Assessment 2794-EM 05/24/2017
Spousal Housing, Income and Resource Questionnaire 2796-EM 05/24/2017
Notification of Parental Financial Responsibility 2849-EM 05/24/2017
Application for Assistance   2905-EG 12/23/2015
Solicitud de Asistencia Pública   2905-EGS  12/23/2015
Discrimination Complaint Policy and Procedures 6513-AP 12/01/2016

Temporary Assistance for Needy Families (TANF) 
 
TITLE
FORM    UPDATED
Statement of Applicant/Recipient Designating Burial Funds 2006-EG 05/24/2017
Income from Farm Operations & Other Self-Employment Operation Worksheet 2011A  05/24/2017
Self-Employment Worksheet 2011-EG 05/24/2017
Insurance Policy Worksheet 2015-EG 05/24/2017
Banking/Loan Activity - Request for Information 2016-EG 05/24/2017
Financial Aid 2020-EF  05/24/2017
Public Law Certification 2022-EM 05/24/2017
VA Benefit Inquiry 2038-EE  05/24/2017
Parental Reimbursement Questionnaire 2069-EM 05/24/2017
Employer Payroll Statement 2074-EG-B 05/24/2017
Self-Employed/Tip Statement 2120-EG 05/24/2017
TANF Cash Benefits Program 2136-EE   09/30/2013
TANF Programas de Beneficios de Dinero 2136-EES  09/30/2013
Interface Consent 2179-EE 05/24/2017
TANF Budget 2183-EE/A 04/26/2017
Voluntary Reduction, Withdrawal or Termination of Assistance 2248-EG 05/24/2017
Conference/Hearings 2254-EH 05/24/2017
Child Care Expense Verification Form 2329-EE 05/24/2017
Benefit Verification Inquiry 2339-EG 05/24/2017
Insufficient Information 2429-EEA 05/24/2017
Authorization to Release Information 2451-EE 05/24/2017
Rent/Household Composition 2488-EG 05/24/2017
Cash Contribution Verification 2506-EG 05/24/2017
Information Needed to Process Your Application 2522-EE 

05/24/2017

Información Necesaria Para Procesar Su Solicitud 2522-EES  11/12/2014
Medical Facility Information 2547-EG 05/24/2017
Change Report Form 2584-EG 05/24/2017
Forma para Reportar Cambios  2584-EGS  05/27/2016
TANF Stepparent/Responsible Parent/Temporary Resident Parent Deeming Budget 2596-EE  03/26/2013
Transfer/Disposal of Asset Notification 2601B 05/24/2017
Joint Ownership of Bank Account 2614-EE 05/24/2017
Assessment and Documentation of Resources 2793-EM 05/24/2017
Request for Resource Assessment 2794-EM 05/24/2017
Spousal Housing, Income and Resource Questionnaire 2796-EM 05/24/2017
Application for Assistance   2905-EG 12/23/2015
Notification of Parental Financial Responsibility 2849-EM 05/24/2017
Solicitud de Asistencia Pública 2905-EGS  12/23/2015
Non-Custodial Parent (NCP) Form 2906-EG 05/24/2017
Formulario Sobre Padres Sin Custodia (NCP) 2906-EGS  06/01/2007
Discrimination Complaint Policy and Procedures 6513-AP 12/01/2016