Public Assistance

Common Forms and Information

• Use the following forms for Public Assistance programs only.
• Refer to E-Forms Index for other forms not listed here.
• These forms are updated regularly. Please use the links below for the most current form.
• Use our Secure Document Upload Portal to quickly and easily submit any requested information.
  

Applications for Public Assistance

Common Forms

• Direct Deposit Request (GEN 153)
  
• Eligibility Review Form (GEN 72)
  
• Request for Case File Records (GEN 35)
• Report of Change Form (GEN 55)
• Authorized Rep/ ROI (GEN 58)
• Employment Statement (GEN 155)
• Fair Hearing Request (GEN 85)

Informational

• Denali KidCare Outreach Flyer (MED 34)
  
• Preparing for your Fair Hearing (DPA 5)
  
• TEFRA Brochure (MED 15)
  
• Temporary Assistance Penalty Brochure (TA 14)
  
• All About Fair Hearings (GEN 84)

Supplemental Nutrition Assistance Program (SNAP)

(Formerly Food Stamps)

• SNAP Make America Stronger Pamphlet (FSP 313)
  
• SNAP Requirements for Eligibility (FSP 79)
  
• SNAP Simplified Reporting Flyer (FSP 82)
• Interim Report eForm
  
• Interim Report Form (GEN 95)
  

Medicaid Trusts

• Qualifying Income Trusts (MED 23)
  
• Special Needs and Pooled Trusts (MED 22)