Your Personal Account for State Services
Benefits and Services Form
Asking questions about your household will help us determine the benefits and services for which you may qualify. Although we can't promise that anyone in your household will receive any benefits or services, we'll be happy to help you learn more about these programs and guide you through the application process. We'll also help you print out a copy of your answers for future reference.
If you would like to learn more about these services, please read the information below and check, "I agree."
I understand and agree that:
I am not applying for any services or benefits by completing this form.
Completing this form does not mean that any household member will receive benefits or services from any of the programs.
I must contact each program to learn more or apply for their benefits or services.
Someone will help me if and when I need it.
Each program will decide whether any of my household members will get benefits or services.
I understand that some programs may ask me to complete other forms, meet with them, or give them proof about my household information before anyone may receive benefits or services.
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