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Applications & Forms

Complete Applications Using the Benefit Finder:

A quick and easy way to apply for programs is to use the Benefit Finder. It saves you time by helping you learn which programs you may qualify for, and helps you fill out applications on-line.

However, if you would like to print a blank copy of the applications and fill them out by hand, click on the applications below.

Print DSHS Applications:

Children’s Health Insurance (Medicaid & SCHIP) – also called Apple Health for Kids
- Information Sheet – a summary of the free and low cost health insurance programs for children under age 19 and simple directions on how to apply
- Renewal Form for Children’s Health Insurance – DSHS will send you a letter when this yearly benefits review is due. You can fill in this form online, print and mail it to the address in the letter.

First Steps (Pregnancy Medicaid)
- Completed applications should be sent to your local DSHS office.

Application for Benefits – use for Food Stamps, Family Medical, TANF, GAU
- Information Sheet – simple directions on how to apply for Food Stamps
- Helpful Hints on using your Food Stamp EBT Card
- Completed Applications for Benefits should be sent to your local DSHS office.

Additional DSHS Forms You May Need:

Income Verification
- Self-employment worksheet – Use this income form if you are self-employed
- Employment Verification – Employers can verify your income using this form
- Stop Work Form – If you stopped work due to a lay-off, temporary status, leave, etc. have your recent employer fill out this form

Other Forms
- Statement of Shared Living Arrangement – explains how the people who live at your address share expenses. This form is used in applying for food stamp benefits.
- Statement from Landlord / Manager – provides proof of your housing costs
- Change of Circumstance Form – report changes of address, income, expenses, family size, etc.
- DSHS Client Rights and Responsibilities – what you need to know about applying for and receiving benefits from DSHS
- DSHS Family and Children’s Medical Benefits Renewal – if your child is already enrolled in Children’s Health Insurance and needs to renew coverage, use this form

Print Basic Health Application:

Currently no applications are needed – Basic Health has a wait list.

Individuals already enrolled or those not subject to the waiting list may need these additional Basic Health Insurance Forms:

Income Verification
- Family Income Worksheet/Reporting Form
- Self employment or Rental Income Reporting Form – You can use this income form if you are self-employed
- Declaration of Non-filing status – Use this form only if you and your spouse did not file a federal income tax return for the most current tax year.