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Forms & Documents

Title

Type

Posted Date

SNAP, Health Care, and TEA-RCA Application Form

   
Application for SNAP, Health Care, and TEA-RCA (mulit-program application) PDF 12/03/2020

Health Care Forms & Documents

   

Medicaid Change Report​

PDF

 

TEFRA Autism Application

PDF

09/18/2020

Quick Reference Medicaid Chart 2020

PDF

03/31/2020

Income Trust Form

PDF

11/30/2018

Income Trust Fact Sheet

PDF

11/30/2018

Medicare Savings Application

PDF

11/30/2018

Medicare Savings Application - Spanish

PDF

11/30/2018

Long Term Care Application for Assistance

PDF

06/13/2018

Long Term Care Application (Spanish)

PDF

06/13/2018

Medicaid Application Form | English

PDF

02/05/2018

Your Guide To Medicaid Estate Recovery In Arkansas

PDF

01/30/2018

Medicaid Application Form | Spanish

PDF  

SNAP Forms & Documents

   

Access Arkansas Online Applications for SNAP

WEB

 

SNAP Application Form

PDF

 

SNAP Application Form | Spanish

PDF

 

SNAP Quick Reference Guide

PDF

 

SNAP Change Report

PDF

 

SNAP Semi-annual Reporting Guide

PDF

 

Electronic Benefits Transfer Card Information

LINK

 

Smart Nutrition Active People-Education | SNAP-ED|

PDF

 

SNAP Employment and Training Counties

PDF

 

SNAP Farmer's Markets

PDF

 

SNAP Double Up Food Dollars

PDF

 

SNAP Double Up Food Bucks - How It Works

PDF

 

SNAP non-discrimination statement (Spanish)

 

 

EBT Training Pamphlet | Spanish

PDF

 

EBT Training Pamphlet | English

   

Transitional Employment Assistance / Refugee Cash Assistance Forms & Documents

 

TEA Application Form | English

PDF

 

TEA Application Form | Spanish

PDF

 

TEA Change Report

PDF

 

Refugee Resettlement Program Application | English

PDF

 

Refugee Resettlement Program Application | Spanish

PDF

 

Community Services Grants Programs Forms & Documents

 

Arkansas Community Action Agencies 2020

 

09/21/2020

Emergency Solutions Grant COVID-19 Subgrantee Contact List

PDF

10/13/2020

Emergency Solution Grant Subgrantee Contact List

PDF

09/21/2020

 
 
Arkansas Department of Human Services
Arkansas Department of Human Services

Arkansas Department
of Human Services
(501) 682-1001

TTY: 1-800-285-1131 or dial 711 for Arkansas Relay Service

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