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For non-clinical questions related to the COVID-19 outbreak, please contact 2-1-1.
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Public Assistance
Forms and Information
Use the following forms for Public Assistance programs only.
Refer to
our offices
for other forms not listed here.
These forms are updated regularly. Please use the links below for the most current form
One Fax for All Offices
DPA’s statewide toll-free fax number is 888-269-6520, and Anchorage area residents can dial 907-269-6520.
Applications for Public Assistance
General
Direct Deposit Request (GEN 153)
Form used to set up a new direct deposit or change bank account information on an existing direct deposit for cash assistance programs (Senior Benefits, Adult Public Assistance, Temporary Assistance)
Eligibility Review Form (GEN 72)
Form used to renew or recertify eligibility for most DPA programs
Request for Case File Records (GEN 35)
Form used to request documents from a DPA case file
Informational
Denali KidCare Outreach Flyer (MED 34)
Promotes Medicaid benefits for children and pregnant women, and provides the monthly income limits
Preparing for your Fair Hearing (DPA 5)
Provides information about how to prepare for a public assistance fair hearing
TEFRA Brochure (MED 15)
Provides information about how children with disabilities living at home may qualify for Medicaid benefits
Temporary Assistance Penalty Brochure (TA 14)
Describes penalties that may occur for certain Alaska Temporary Assistance Program participants
Supplemental Nutrition Assistance Program
(SNAP, formerly Food Stamps)
SNAP Make America Stronger Pamphlet (FSP 313)
Promotes SNAP benefits and provides the monthly income limits and maximum allotments
SNAP Requirements for Eligibility (FSP 79)
Overview of SNAP eligibility requirements
SNAP Simplified Reporting Flyer (FSP 82)
Provides information about
reporting requirements
for SNAP households
Medicaid Trusts
Qualifying Income Trusts (MED 23)
Provides information about establishing a Qualifying Income Trust (aka Miller’s Trust) when an individual has too much countable income to qualify for Medicaid benefits
Special Needs and Pooled Trusts (MED 22)
Provides information about establishing a Special Needs or Pooled Trust when a disabled individual has too much countable income or too many countable resources to qualifying for Medicaid benefits
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