SNAP, Health Care, and TEA-RCA Application Form

Title	Type	Posted Date
Application for SNAP, Health Care, and TEA-RCA (multi-program application) – English	PDF	09/01/2022
Application for SNAP, Health Care, and TEA-RCA (multi-program application) – Spanish	PDF	09/01/2022
Application for SNAP, Health Care, and TEA-RCA (multi-program application) – Marshallese	PDF	12/03/2020

Health Care Forms & Documents

Title	Type	Posted Date
Form 1095-B: Health Coverage	LINK	01/12/2021
Medicare Savings Application	PDF	09/30/2022
Medicare Savings Application – Spanish	PDF	09/30/2022
Medicaid Change Report​	PDF
Quick Reference Medicaid Chart 2024	PDF	04/01/2024
Income Trust Form	PDF	07/01/2022
Income Trust Fact Sheet	PDF	07/01/2022
Your Guide To Medicaid Estate Recovery In Arkansas	PDF	01/30/2018

SNAP Forms & Documents

Title	Type	Posted Date
SNAP Forms & Documents
Access Arkansas Online Applications for SNAP	WEB
SNAP Quick Reference Guide	PDF	10/01/2023
SNAP Change Report	PDF
Electronic Benefits Transfer Card Information	LINK
Smart Nutrition Active People-Education | SNAP-ED|	LINK
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	LINK
SNAP non-discrimination statement (Spanish)	PDF
EBT Training Pamphlet | Spanish	PDF
EBT Training Pamphlet | English	PDF

Transitional Employment Assistance / Refugee Cash Assistance Forms & Documents

Title	Type	Posted Date
Transitional Employment Assistance / Refugee Cash Assistance Forms & Documents
TEA Change Report	PDF
TEA Application	PDF	12/2020
TEA Quick Reference Guide 2024	PDF	4/2024

Community Services Grants Programs Forms & Documents

Title	Type	Posted Date
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