Pennsylvania Department of Human Services Forms

This type of document is a medical assistance application form for workers with disabilities in Pennsylvania.

This document is used for applying for economic eligibility for medical assistance and long-term care services in Pennsylvania.

This form is used for authorizing the use or disclosure of personal information in Pennsylvania.

This form is used for applying for Medical Assistance (Medicaid) in Pennsylvania for long term care, supports, and services.

This type of document is an authorization form used in Pennsylvania to request permission for the use or disclosure of private information.

This Form is used for applying for Emergency Rental Assistance in Pennsylvania. It is used to help tenants who are struggling to pay their rent due to a financial hardship resulting from the COVID-19 pandemic.

This document is a form used for applying for Emergency Rental Assistance in Pennsylvania. It is available in Chinese language.

This Form is used for requesting emergency rental assistance in Pennsylvania.

This form is used for applying for emergency rental assistance in Pennsylvania. It is available in Arabic.

This Form is used for Vietnamese speakers in Pennsylvania to apply for the Emergency Rental Assistance program.

This form is used for applying for Emergency Rental Assistance in Pennsylvania specifically for Cambodian residents.

This form is used for applying for Emergency Rental Assistance in Pennsylvania. It is available in Russian.

This form is used for applying to the Low Income Household Water Assistance Program (LIHWAP) in Pennsylvania. It helps low-income households get assistance with their water bills.

This form is used for explaining the absence of proof for Emergency Rental Assistance in Pennsylvania.

This type of document is a form used in Pennsylvania to explain the absence of proof for emergency rental assistance in Arabic language.

This form is used for explaining the absence of proof for Emergency Rental Assistance in Pennsylvania for Cambodian residents.

This form is used by physicians in Pennsylvania to certify the health condition of an individual, often required for specific health services or insurance claims.

This form is used in Pennsylvania for evaluating an individual's ability to work. Specifically, it assesses multiple factors including physical, mental, and emotional capacities that impact a person's potential for employment.