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NH Department of Health and Human Services (HHS) Division of Family Assistance (DFA) DFA Form 778 01/16 AUTHORIZED REPRESENTATIVE (AR) DECLARATION You may choose an Authorized Representative (AR)

How to fill out nh dhhs form 778

How to fill out NH DFA form 778:

1. Start by accessing the NH DFA website or visiting the nearest NH DFA office to obtain a copy of form 778.
2. Open the form and read the instructions carefully. Make sure you understand the purpose of the form and the information required.
3. Begin filling out the personal information section. Provide your full legal name, address, phone number, and social security number.
4. Proceed to the income section. Include all sources of income and their respective amounts. This may include wages, self-employment income, pension, rental income, or any other income you receive.
5. If you have any deductions or adjustments to your income, indicate them in the designated section. This could include student loan interest deductions or self-employment tax deductions, for example.
6. Next, provide information about your household size. Include the number of people living with you and their relationship to you.
7. If you have any dependents, you will need to provide their names, social security numbers, and relationships to you.
8. In the assets section, list all of your assets such as bank accounts, investments, real estate, and vehicles. Include the current value or balance of each asset.
9. If you own a home, you will need to provide additional information about the property, such as the address, market value, and outstanding mortgage balance.
10. Complete any other required sections or questions on the form. Make sure you have reviewed your responses to ensure accuracy.
11. Once you have filled out all the necessary information, sign and date the form.
12. Finally, submit the completed NH DFA form 778 to the appropriate NH DFA office or follow the instructions provided by the department.

Who needs NH DFA form 778:

1. Individuals who reside in New Hampshire and are applying for or receiving state assistance programs may need to fill out NH DFA form 778.
2. This form is typically required for determining eligibility and the amount of benefits individuals may qualify for.
3. Some of the programs that may require the completion of form 778 include Temporary Assistance for Needy Families (TANF), Supplemental Nutrition Assistance Program (SNAP), and Medicaid, among others.
4. It is important to consult with the specific program you are applying for to determine if NH DFA form 778 is required. They will provide guidance on the necessary forms and procedures.

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