The following forms can be printed and mailed or faxed to the Division of Economic Support for your convenience:
(All forms requires Adobe Acrobat Reader Version 4.0 or above, available free from Adobe.)

• Apply for or check on my benefits
  
  
• Application for Food Share - establishes an application date. You still need to contact us at 608-742-9227 to get registered and receive an appointment.
  
  
• Mail-in Application for Family Medicaid - use to apply for Medicaid for a pregnant woman, children, or parents living with their children. You have the option of using a mail-in form or calling 608-742-9227 for an appointment. The information is recorded by the ES staff at an interview so no application form needs to be completed by you if you elect to come in and apply.
  
  
• Mail-in Application for Elderly, Blind or Disabled - use to apply for Medicaid for an elderly person or for someone who has been determined to be disabled by Social Security/Disability Determination Bureau. You have the option of using a mail-in form or calling 608-742-9227 for an appointment. The information is recorded by the ES staff at an interview so no application form needs to be completed by you if you elect to come in and apply.
  
  
• Change Report Form - use to report changes in your circumstances such as changes in income, address/shelter expenses, household members. Changes must be reported within 10 days if you have an open case and are receiving benefits.
  
  
• Verification of Residence Form - use to send or bring in proof of residence or shelter expenses.
  
  
• Verification of Employment - use to send or bring in proof of employment income.
  
  
• Self-Employment Income Form - use to report self-employment earnings. You will usually need six of these since self-employment earnings are averaged over a six month period.

In accordance with Federal law and U.S. Department of Agriculture policy, this institution is prohibited from discriminating on the basis of race, color, national origin, sex, age, religion, political beliefs or disability.

To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, Room 326-W, Whitten Building, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410 or call (202) 720-5964 (voice and TDD).  USDA is an equal opportunity provider and employer.