Forms & Documents

Forms & Documents

SNAP, Health Care, and TEA Application Form

TitleTypePosted Date
Application for SNAP, Health Care, and TEA (multi-program application) – EnglishPDF12/01/2024
Application for SNAP, Health Care, and TEA (multi-program application) – SpanishPDF09/01/2022
Application for SNAP, Health Care, and TEA (multi-program application) – MarshallesePDF12/03/2020
Access Arkansas Online Application for SNAP, Health Care, and TEAWEB

Health Care Forms & Documents

TitleTypePosted Date
Form 1095-B: Health CoverageLINK01/12/2021
Medicare Savings ApplicationPDF12/01/2024
Medicare Savings Application – SpanishPDF09/30/2022
Medicaid Change Report​PDF
Quick Reference Medicaid Chart 2024PDF04/01/2025
Income Trust FormPDF01/01/2025
Income Trust Fact SheetPDF07/01/2022
Your Guide To Medicaid Estate Recovery In ArkansasPDF01/30/2018

SNAP Forms & Documents

TitleTypePosted Date
SNAP Forms & Documents
SNAP Quick Reference GuidePDF10/01/2024
SNAP Change ReportPDF10/01/2024
Smart Nutrition Active People-Education | SNAP-ED|LINK
SNAP Employment and Training CountiesPDF
SNAP Farmer’s MarketsPDF
SNAP Double Up Food DollarsPDF
Complaint FormPDF12/2024
Complaint Form – SpanishPDF12/2024

Transitional Employment Assistance

TitleTypePosted Date
Transitional Employment Assistance & Documents
TEA Change ReportPDF
TEA ApplicationPDF12/2024
TEA Quick Reference Guide 2024PDF4/2024

Community Services Grants Programs Forms & Documents

TitleTypePosted Date
Community Services Grants Programs Forms & Documents
Arkansas Community Action Agencies01/01/2025