Public Assistance Templates

Are you in need of financial assistance? Our public assistance program offers support to individuals and families who are facing economic challenges. We understand that navigating the process can be overwhelming, which is why we have compiled a collection of helpful resources for you.

Our public assistance forms are designed to simplify the application and recertification process. Whether you are applying for the Supplemental Nutrition Assistance Program (SNAP) in New York, seeking substance use disorder requirements assistance in Washington, or in need of utility information in New York City, we have the forms to help you. Additionally, if you are in California, our CalFresh benefits application form is available to you. We have thoughtfully created these forms to ensure that they are accessible and user-friendly.

At, we recognize that the diverse needs of our community require support in various languages. That's why we have translated instructions for our public assistance forms into Italian for applicants in New York and into German for those in Wisconsin. We strive to make our services inclusive and accessible to all.

Rest assured that these resources were developed to provide guidance and support throughout the public assistance process. We understand the importance of timely assistance, and our team is committed to ensuring that you receive the help you need when you need it the most.

If you are seeking public assistance, explore our collection of resources and forms to make the process as smooth as possible. We are here to assist you every step of the way.




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This Form is used for applying for redetermination of eligibility for benefits in the state of Illinois.

This document is used for informing CalFresh recipients in California about the intercounty transfer of their benefits. It provides important information regarding the transfer process and any changes that may occur.

This form is used for reporting changes in income and household information for CalWORKs and CalFresh programs in California.

This Form is used for sending a reminder notice regarding the Sar 7 report to be filed in California.

This Form is used for notifying individuals in California who have received an overissuance of CalFresh benefits due to intentional program violation.

This form is used for the Access NY program in New York. It is a supplement form in Spanish (DOH-4495A Suplemento A) for applicants who need assistance in accessing healthcare and other benefits.

This Form is used for determining the eligibility of families for certain benefits in New York. It serves as a checklist to ensure all necessary information and documentation is provided.

This form is used for notifying applicants or participants about the approval of their Supplemental Nutrition Benefit (SNB) Program in California.

This document is a form provided by the Washington Department of Social and Health Services (DSHS) for individuals receiving cash and food assistance. It outlines the rights and responsibilities of recipients and is available in French.

This form is used for Vietnamese-speaking individuals in Washington who need to provide a statement from their school for Department of Social and Health Services purposes.

This Form is used for creating a WorkFirst Individual Responsibility Plan for residents of Washington who speak Nepali. It helps outline goals and responsibilities for individuals participating in the WorkFirst program.

This form is used for applying for the No Paid Services Group in Washington for Somali speakers. It is used by the Department of Social and Health Services to determine eligibility for certain benefits or services.

This document is for submitting an interim report form for the SNAP (Supplemental Nutrition Assistance Program) in Rhode Island. The form is available in Portuguese.

This form is used for recertification of the GUR benefits in South Carolina for individuals who speak Gujarati.

This document is used for referring individuals to the SNAP Employment and Training Program in South Carolina who may be subject to the Able-Bodied Adults Without Dependents (ABAWD) requirements.

This type of document, Form FL All Family132 Declaration About Public Assistance, is used in Washington to declare information about public assistance programs.

This form is used for individuals living in Washington state who are of Cambodian descent to provide information about their resources and expenses. It is used to determine eligibility for various assistance programs.

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