Virginia Department of Social Services Forms

This document is a communication form used by providers and the Department of Social Services (DSS) in Virginia. It is used to facilitate communication and exchange of information between these parties.

This form is used for applying for fuel assistance in Virginia. It is an application form that residents can fill out to request assistance with their fuel bills.

This form is used for applying for crisis assistance in Virginia.

This document is a formal agreement used in the state of Virginia for providers of auxiliary grants. It outlines the terms and conditions of the agreement between the provider and the state.

This document is for requesting crisis assistance in the state of Virginia. It is available in Spanish.

This type of document is used for adding new members with assistance to the Temporary Assistance for Needy Families (TANF) program in Virginia.

This Form is used for applying for health coverage and financial assistance in Virginia.

This document is used for requesting medical coverage and assistance with the payment of costs for individuals with medical needs in Virginia.

This form is used for renewing applications for Auxiliary Grant (AG), Supplemental Nutrition Assistance Program (SNAP), and Temporary Assistance for Needy Families (TANF) in Virginia.

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 document is a Spanish version of Appendix D - Application for Health Coverage and Help Paying Costs in Virginia. It is used to apply for health coverage and financial assistance with healthcare costs in Virginia.

This form is used for applying for benefits in the state of Virginia. It is used to provide information and documentation to determine eligibility for various assistance programs.

This form is used for filing an asset transfer undue hardship claim in the state of Virginia.

This form is used for requesting the renewal of auxiliary grant, supplemental nutrition assistance program (SNAP), and temporary assistance for needy families (TANF) in Virginia. (Spanish)

This form is used for applying for health coverage and financial assistance for healthcare costs in the state of Virginia.

This type of document is used for applying for health coverage and financial assistance in Virginia.

This Form is used for placing an order for publications in Virginia.

This form is used for agreeing on the code of ethics and mutual responsibilities in foster care in Virginia.

This form is used for authorizing the use of a debit card in Virginia. It allows individuals to grant permission for specific transactions to be made using their debit card.

This form is used for completing a child fatality checklist in the state of Virginia. It is a document that helps gather important information and assess any potential risks or factors that contributed to a child's death.

This Form is used for ensuring residential environments in children's residential facilities comply with regulations in Virginia.

This form is used for applying for an auxiliary grant certification in the state of Virginia.

This Form is used for applying to renew a license to operate a Child Day Center (CDC) in the state of Virginia.

This form is used for applying for fuel assistance in the state of Virginia.

This form is used for displaying the weekly menu in the state of Virginia. It provides information about the food options available for each day of the week.

This form is used for assessing the strengths and needs of families in Virginia. It helps determine what support services or resources are necessary to enhance family well-being.

This form is used for ordering publications in the state of Virginia.

This document is used to disclose important information about an assisted living facility in Virginia. It provides details about the services, fees, policies, and other information that potential residents need to know before moving into the facility.

This Form is used for submitting an initial application to obtain a license for operating a Child Day Center (CDC) in the state of Virginia.

This Form is used for renewing a license to operate a Children's Residential Facility (CRF) in Virginia.

This Form is used for providing information about the staff-child ratio in Virginia. It helps to ensure a proper balance between staff and children in various settings such as schools, daycare centers, and child care facilities.

This Form is used for submitting a statement of intent in the state of Virginia. It gathers information about a person's intention to establish residency or domicile in Virginia.

This form is used for applying for cooling assistance in the state of Virginia.