Forms for TANF clients
Many of the forms that you may need to submit as part of your TANF case are below.
If you need help understanding or completing any of these forms, you can always contact your caseworker.
Our Economic Assistance Eligibility Client Services team is also available to help. You can reach them at 800-948-3050.
application
SNAP / TANF Application (MDHS EA Form 900)
English | Spanish | Vietnamese
- Use the SNAP/TANF Application (MDHS EA Form 900) to apply for SNAP benefits and/or TANF benefits. You can complete this form if you are applying for SNAP or TANF for the first time or if you need to recertify for benefits.
- For more information on how to submit your application, see our Applying for SNAP page or our Applying for TANF page.
Reporting and verification forms
SNAP/TANF Employment Wage Verification Form (MDHS EA Form 910)
English | Spanish | Vietnamese
- Use the SNAP/TANF Employment Wage Verification Form (MDHS EA Form 910) if your caseworker asks you to get an Employment Wage Verification form completed by your current or former employer.
SNAP/TANF Change Reporting Form (MDHS EA Form 946)
English | Spanish | Vietnamese
- Use the SNAP/TANF Change Reporting Form (MDHS EA Form 946) to report any changes to your household’s circumstances, including a change in your income, someone moving into or out of your household, changes in your rent or mortgage amount, and more.
- See the TANF Rights and Responsibilities form below for the full list of changes that must be reported to MDHS within 10 days.
tanf participant forms
TANF Rights and Responsibilities
English | Spanish | Vietnamese
- All TANF households have both rights and responsibilities. The TANF Rights and Responsibilities form (MDHS EA Form 300) lists the rights and responsibilities of TANF applicants and recipients.
TANF Work Program (TWP) Participant Travel Form (MDHS EA Form 357)
English | Spanish | Vietnamese
- TWP participants use this form to report how they will travel to/from work sites.
TANF Child Care Services Application (MDHS EA Form 379)
English | Spanish | Vietnamese
- TANF Work Program participants can use this form to expedite application for child care services under the TWP.
TANF Child Care Provider Selection Form (MDHS EA Form 380)
English | Spanish | Vietnamese
- TANF Work Program participants can use this form to expedite application for child care services under the TWP.
administrative hearing forms
MDHS Programmatic Appeal Request (MDHS-OIG-200)
- Use the MDHS Programmatic Appeal Request form (MDHS-OIG-200) to request a fair hearing.
Administrative Disqualification Hearing Waiver (MDHS Form F091)
- Use the Administrative Disqualification Hearing Waiver Form (MDHS Form F091) if you would like to waive your right to an Administrative Disqualification Hearing.
Administrative Hearing Face-to-Face Hearing Request (MDHS Form F091A)
- Use the Administrative Hearing Face-to-Face Hearing Request form (MDHS Form F091A) if you want to request a face-to-face hearing instead of having your hearing conducted over the phone.
Request for Continuance of Administrative Hearing Date (MDHS EA Form 956)
- Use the Request for Continuance of Administrative Hearing Date form (MDHS EA Form 956) if you would like to request a change to the administrative (fair) hearing date that was listed on your hearing notice.
Contact Us
Economic Assistance Eligibility Client Services
Need help with your SNAP or TANF case? Call our EAE Client Services team at 800-948-3050.