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Division of Family Assistance Applications & Forms
The Division of Family Assistance recently launched NH EASY, New Hampshire's Electronic Application System. Learn how to apply for assistance, check eligibility, track your application status and more by visiting the NH EASY web page.

Applications

  • To apply for cash, Food Stamp benefits, Medicaid, and Child Care assistance, use both the Application for Assistance (Form 800) (English) (Spanish) (Nepali) Adobe Acrobat Reader Symbol and the Medical Assistance for Children, Pregnant Women, & Parent/Caretaker Relatives Insert (Form 800 Insert) (English) Adobe Acrobat Reader Symbol
  • Authorized Representative (Form 778) (English) (Spanish) (Bosnian) Adobe Acrobat Reader Symbol
  • Application for Children's Medicaid (CM) and Medical Coverage for Pregnant Women (MCPW) (Form 800P) (English) (Spanish) (Nepali) Adobe Acrobat Reader Symbol
  • Application for Health Coverage and Help Paying Costs (Form 800MA)
    (English) (Spanish) Adobe Acrobat Reader Symbol
  • Your Rights & Responsibilities (Form 811R) (English) (Spanish) (Nepali) Adobe Acrobat Reader Symbol

Verifications

Additional Information

Adobe Acrobat Reader Symbol Adobe Acrobat Reader format. You can download a free reader from Adobe.

 
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Disclaimer

New Hampshire Department of Health and Human Services
129 Pleasant Street | Concord, NH | 03301-3852


copyright 2010. State of New Hampshire