Low Income Templates

This document is an addition to the exemption application for housing for low-income persons in the state of Kansas. It provides additional information or updates to the original application.

This type of document is used for applying to be approved as an indigent criminal defense counsel in Butler County, Ohio.

This document is used in Tennessee to declare a person's inability to afford legal fees. It is used to request a waiver of court costs and other expenses due to financial hardship.

This form is used for claiming the Low-Income Caregiver Credit in the state of Oregon.

This Form is used for the CalFresh Program in California to set up a Restricted Account Agreement.

This form is used for notifying recipients of the Food Stamp program in California about their benefits being discontinued.

This form is used for applying for reimbursement under the FCC's Low Income Broadband Pilot Program.

This Form is used for applying for State Emergency Relief in Michigan. It is specifically designed to help individuals and families who are facing a crisis or emergency situation and are in need of financial assistance.

This form is used for filing an Affidavit of Indigency in the state of Michigan. It is a document that allows individuals to request a waiver of court fees based on their financial inability to pay.

This form is used for low-income individuals and needy care providers in the state of Nevada to enter into a collaboration agreement.

This form is used to apply for presumptive eligibility for Medicaid in Nevada. It allows individuals to receive temporary coverage while waiting for their full Medicaid application to be processed.

This form is used for low-income housing tax credit properties in New Hampshire to make an alternate assessment election.

This document is for the designation of Competitive Eligible Telecommunication Carriers (CETCs) in Ohio for providing low-income universal service. CETCs are approved providers that offer affordable telecommunication services to eligible low-income residents in the state.

This form is used for reporting low-income housing tax credit carryback and/or carryforward in the state of Utah.

This document is a form provided by the Washington Department of Social and Health Services (DSHS) for individuals receiving cash and food assistance. It outlines the rights and responsibilities of recipients and is available in French.

This document is for applying for health coverage and financial assistance for medical costs in Virginia for individuals who meet the medically needy spenddown criteria. You can use Appendix E to seek help if you have high medical expenses but don't qualify for regular Medicaid.

This form is used to apply for the Low Income Taxpayer Clinic (LITC) program offered by the IRS. The application requires a written narrative that provides information about the clinic's qualifications and experience in providing tax assistance to low-income taxpayers.

This form is used for applying for medical benefits through mail in the state of Illinois.

This form is used for requesting a waiver to have a 14-day cash on hand requirement for the Iowa LIHEAP program.

This form is used for claiming the Low-Income Individuals and Families Tax Credit in Canada. It is a schedule that needs to be filled out and submitted along with Form 5006-A. This tax credit is designed to provide financial assistance to individuals and families with low incomes.

This form is used for applying for low and moderate income homeowners property tax relief in the state of New Hampshire.

This form is used for notifying individuals in Texas about their potential eligibility for the Medicaid Buy-In program.

This form is used for referring individuals in Texas to apply for Supplemental Security Income (SSI) benefits. It provides necessary information to the relevant authorities for determining eligibility.

This form is used for notifying individuals in Texas about the Medicare Savings Program.