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DSS-EA-240 09/09 Recipient # Section 1 Application for Long Term Care or Related Medical Assistance For Office Use Only Instructions to the Person Applying for Assistance Please read all questions
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Who needs dss ea 240 0909?
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Individuals seeking assistance or benefits from the Department of Social Services (DSS) may need to fill out the form DSS EA 240 0909.
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Applicants for programs such as Temporary Assistance for Needy Families (TANF), Supplemental Nutrition Assistance Program (SNAP), or Medicaid may be required to complete this form.
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The form is also used by DSS caseworkers, administrators, and other personnel involved in the processing and evaluation of the individual's eligibility for benefits.
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