New Hampshire Department of Health and Human Services - Bureau of Family Assistance Forms

This type of document is used in New Hampshire to apply for medical assistance for children, pregnant women, and parent/caretaker relatives.

This form is used for requesting emergency assistance in New Hampshire. It is specifically designed for Spanish-speaking individuals.

This Form is used for applying for medical assistance in New Hampshire for children, pregnant women, and parent/caretaker relatives.

This form is used for applying for emergency assistance in the state of New Hampshire.

This form is used for applying for retroactive medical assistance in New Hampshire.

This Form is used for reimbursement agreement and acknowledgment in New Hampshire.

This document is a BFA Formulario 778 Declaracion Del Representante Autorizado (Ra) in Spanish for the state of New Hampshire. It is used for declaring an authorized representative.

This Form is used for the authorized user agreement for the Partners in Health (PIH) application in New Hampshire.

This form is used for requesting to determine presumptive eligibility for healthcare coverage in New Hampshire.

This form is used for reporting changes in the Snap Program benefits in New Hampshire.

This form is used for certifying continued absence in New Hampshire. It is available in Spanish.