Completing an Application for Assistance is the first step in receiving help.  The application is used to apply for any or all programs including:

• Food Stamps

• Financial Assistance  - Temporary Assistance for Needy Families (TANF); Old Age Assistance (OAA); Aid to the Permanently and Totally Disabled (APTD); Aid to the Needy Blind (ANB) 

• Child Care Assistance

• Emergency Assistance (for those not receiving TANF cash assistance)

• Medical Assistance - Medicaid for seniors, blind or disabled individuals, or families with children; Nursing Facility Care; Medicare Beneficiaries Savings Programs; Medicaid for Employed Adults with Disabilities; Medical Coverage for Pregnant Women; NH Healthy Kids; Emergency Medicaid

It is important to read all the information on the application.  Answer all the questions to the best of your ability, but do not answer anything you do not understand.  If you need help in filling out this application, you may ask someone to help or, after completing the application, your Family Services Specialist will help you during your interview.

The Application for Assistance (7 pages) can be printed, completed and returned in person to a DHHS District Office.  You can also mail the completed application and copies of documents needed to verify eligibility to a District Office and a DHHS representative will contact you to come in for an interview.  You may also request an application be mailed to you by calling a DHHS District Office.  District Office phone numbers are available by clicking on the Contact Info tab above.

Puede imprimir, llenar y devolver personalmente la Solicitud Para Asistencia (7 páginas) a una Oficina del Distrito del DHHS. También puede llenar la solicitud y enviarla por correo, junto con las copias de los documentos necesarios para verificar que cumple con los requisitos, a una Oficina del Distrito. Un representante del DHHS se pondrá en contacto con usted para concertar una entrevista. También puede llamar a una Oficina del Distrito del DHHS y pedir que le manden una solicitud por correo. Para los números de teléfono, haga clic en la lengüeta de información de contacto arriba. 

Zahtjev (Application) (14 pages)

Related Forms and Documents

• Employment Verification- Form 756
• Rental Verification- Form 775
• Authorized Representative Request- Form 778
• Documents Needed to Verify Eligibility
• Your Rights and Responsibilities