Applications

All applications are in pdf format 

• Cover sheet and Application for Assistance (DHS-2), 9/2016 
  [Application for Assistance- Spanish], 9/2016  
  [Application for Assistance- Portuguese] 9/2016
  Use this application to apply for the following programs: RI Works, Supplemental Nutrition Assistance Program, Child Care Assistance Program, General Public Assistance, RI SSI State Supplemental Payment Program, Affordable Care Coverage (includes Medicaid and private health insurance with financial help), Medicaid Long-Term Services and Supports (LTSS), Medicaid health coverage for low-income elders and persons with disabilities, Sherlock Plan, Medicare Premium Payment Program, and Katie Beckett.
  Mail the completed application to: Department of Human Services, P.O. Box 8709, Cranston, RI 02920-8787. For more information on these programs, see Programs and Services.
  
  Please Note: If you are completing a Application for Assistance (DHS-2) for Long Term Care (also called Long Term Services and Supports) for nursing home or home care, please the Application for Assistance (DHS-2) and these additional forms. Mail the completed application to the DHS Long Term Care Unit, 206 Elmwood Ave., Providence, RI 02907.  
• Medicare Premium Payment Program (MPP-1), 02/2017 
• Application for State Assistance Program, 2/2021    
• Respite for Children Application, 7/2016
• Respite for Children Recertification, 7/2016