Applications and forms
SCDJFS 6126 Applicant Questionnaire
SCDJFS 7002 Employment Wage Verification
SCDJFS 7029 Change Report with Voter Registration
SCDJFS 7158 Application for TANF Services with Voter Registration (PRC Application)
JFS 01124 Re-Determination Application for Child Care Benefits (open case – ongoing)
JFS 01138 Application for Child Care Benefits (new applicant)
JFS 07200 Request for Cash, Food and Medical Assistance
• Food and Nutrition Service (FNS) Nondiscrimination Statement
JFS 07204 Request to Reapply for Cash and Food Assistance
JFS 07501 Program Enrollment and Benefit Information
ODM 02399 Request for Medicaid Home & Community-Based Services
ODM 03528 Healthchek and Pregnancy Related Services Information Sheet
ODM 06723 Designation of Authorized Representative
ODM 07216 Application for Health Coverage & Help Paying Costs