You must complete and turn in an assistance application to determine if you are able to get benefits (food, Medicaid, temporary cash assistance, etc.) through the Department of Human Services (DHS). When you file an application you need to provide information about all of the members in your household.

• Filing Document (DHS-1171-F) - If you cannot complete the entire application on the first day you come to your local DHS office, you can start the time period by completing and turning in this form. Before you can get help, you must complete the questions on the Assistance Application.
• Assistance Application (DHS-1171) - This application is used to apply for food, medical assistance, child day care, temporary cash and help with emergencies.
• Retroactive Medicaid Application (DHS-3243) - This application is completed for persons in your household who have unpaid medical expenses in one or more of the three months before the date an Assistance Application is submitted.
• Child Development and Care Application (DHS-4583) - Complete this application when you are applying only for child care. This application may not be used to apply for any other DHS programs.
• Application for State Emergency Relief (DHS-1514) - If you need help with an emergency from the State Emergency Relief (SER) program you will have to complete both this application and the Assistance Application (DHS-1171). Exception: If you currently receive benefits from DHS you may not have to complete both applications. Check with your specialist to find out.
• Medicaid Application, Patient of Nursing Home (DHS-4574) - This application is used to apply for a patient, or someone who will soon become a patient, of a nursing facility.