Public Assistance Templates

This document certifies chronic homelessness status in Georgia, United States.

This document is used to cancel direct deposit for certain benefits in New York for individuals who speak Haitian Creole.

This Form is used for applying and certifying for TANF (Temporary Assistance for Needy Families) services in the state of New York.

This form is used for applying for TANF Youth Services in New York. It is available in both English and Arabic languages.

This Form is used for applying for TANF (Temporary Assistance for Needy Families) services in New York for Russian-speaking individuals and families.

This form is used for requesting authorization to act as an authorized representative for the Supplemental Nutrition Assistance Program (SNAP) in New York.

This form is used for reporting welfare fraud in New York. It is available in Spanish.

This form is used for determining eligibility to extend the CalWORKs 60-month time limit in California.

This form is used for applying for SNAP benefits (food assistance) specifically for seniors in Massachusetts.

This form is used for documenting substance use disorder requirements for individuals receiving assistance through the Abd/Pwa program in Washington. It is important for individuals to complete this form accurately to ensure they meet the necessary requirements for continued assistance.

This document is a financial questionnaire used in New Jersey to determine indigency eligibility for individuals who speak English or Haitian Creole.

This form is used for conducting a preliminary damage assessment site estimate in Arizona. It helps to evaluate and estimate the extent of damage caused by a disaster or emergency situation.

This form is used for applying to the DHEC Healthy Connections program in South Carolina. It is an application for health care assistance.

This document is an application for burial assistance in Washington, D.C. It is used by individuals seeking financial assistance for the costs associated with funerals and burials.

This document is for requesting a time extension for a public assistance project in Wisconsin. It is used to seek additional time to complete the project and meet the required deadlines.

This document notifies Hmong individuals in Wisconsin about their disqualification from the Foodshare program.

This form is used for notifying individuals in Wisconsin who have been disqualified from receiving Foodshare benefits in German language.

This form is used for requesting a fair hearing in the state of California. It allows individuals to seek resolution and address concerns related to various state programs and benefits.

This form is used for notifying the North Carolina Department of Social Services regarding any changes or updates to public assistance benefits, including modifications, terminations, or continuations.

This form is used for applying for CalFresh benefits in California. CalFresh is a program that provides eligible low-income individuals and families with funds to purchase food.

This Form is used for Medicaid and State Supplemental Review in the state of Iowa.

This form is used for the recertification of certain benefits and services in New York State. It is available in Polish.