Forms & Documents

Forms & Documents

SNAP, Health Care, and TEA-RCA Application Form

TitleTypePosted Date
Application for SNAP, Health Care, and TEA-RCA (multi-program application) – EnglishPDF12/03/2020
Application for SNAP, Health Care, and TEA-RCA (multi-program application) – SpanishPDF12/03/2020
Application for SNAP, Health Care, and TEA-RCA (multi-program application) – MarshallesePDF12/03/2020

Health Care Forms & Documents

TitleTypePosted Date
Form 1095-B: Health CoverageLINK01/12/2021
Medicare Savings ApplicationPDF11/30/2018
Medicare Savings Application – SpanishPDF11/30/2018
Medicaid Change Report​PDF
Quick Reference Medicaid Chart 2021PDF04/28/2021
Income Trust FormPDF11/30/2018
Income Trust Fact SheetPDF11/30/2018
Your Guide To Medicaid Estate Recovery In ArkansasPDF01/30/2018

SNAP Forms & Documents

TitleTypePosted Date
SNAP Forms & Documents
Access Arkansas Online Applications for SNAPWEB
SNAP Quick Reference GuidePDF
SNAP Change ReportPDF
SNAP Semi-annual Reporting GuidePDF
Electronic Benefits Transfer Card InformationLINK
Smart Nutrition Active People-Education | SNAP-ED|LINK
SNAP Employment and Training CountiesPDF
SNAP Farmer’s MarketsPDF
SNAP Double Up Food DollarsPDF
SNAP Double Up Food Bucks – How It WorksLINK
SNAP non-discrimination statement (Spanish)PDF
EBT Training Pamphlet | SpanishPDF
EBT Training Pamphlet | EnglishPDF

Transitional Employment Assistance / Refugee Cash Assistance Forms & Documents

TitleTypePosted Date
Transitional Employment Assistance / Refugee Cash Assistance Forms & Documents
TEA Change ReportPDF

Community Services Grants Programs Forms & Documents

TitleTypePosted Date
Community Services Grants Programs Forms & Documents
Arkansas Community Action Agencies 202009/21/2020
Emergency Solutions Grant COVID-19 Subgrantee Contact ListPDF10/13/2020
Emergency Solution Grant Subgrantee Contact ListPDF09/21/2020

DCO Address

PO Box 1437, Slot S301
Little Rock, AR 72203

DCO Phone Number

501-682-8375
855-372-1084 Statewide
TDD: 501-682-8820

Learn About Programs

Apply For Services

Find Service Providers

Do Business With DHS

Become A Provider

Report A Concern

Copyright 2021 © All Rights Reserved. Arkansas.gov