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MI DHS-1514 2010 free printable template

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Case Name Case Number Date DHS Office Specialist Phone Fax Client ID APPLICATION FOR STATE EMERGENCY RELIEF Michigan Department of Human Services I hereby make application for the State Emergency Relief SER Program. I understand that the following information will be used in the determination of my eligibility for SER. If this application is for burial services I understand that it must be received by the DHS office in my area no later than 10 calendar days after the burial cremation or...
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How to fill out MI DHS-1514

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How to fill out MI DHS-1514

01
Obtain the MI DHS-1514 form from the Michigan Department of Health and Human Services website or your local office.
02
Fill in your personal details at the top, including your name, address, and date of birth.
03
Provide information about your household members, including their names and relationship to you.
04
Complete the income section by detailing your sources of income, including wages, benefits, and any other income you receive.
05
Include information about your expenses, such as housing costs, utilities, and other necessary expenses.
06
Sign and date the form at the designated area, certifying that all information provided is accurate and complete.
07
Submit the completed form to your local MI DHS office either in person or via mail.

Who needs MI DHS-1514?

01
Individuals and families seeking assistance or benefits from the Michigan Department of Health and Human Services may need to fill out the MI DHS-1514 form.
02
People applying for food assistance, cash assistance, or other types of social services are required to submit this form.
03
Anyone experiencing financial hardship may need to complete this form to determine eligibility for state assistance programs.

Who uses the Form DHS-1514?

A resident of the State of Michigan might find himself in an emergency situation where he is constrained to ask for assistance. For instance, if a person fails to pay mortgage, electricity bills, property taxes, homeowner’s insurance etc. he should use the DHS-1514 to apply for help to the

The Michigan Department of Health and Human Services (MD HHS).

To qualify for State Emergency Relief, the applicant must meet certain requirements. In general, eligibility is based on the number of individuals in the applicant’s household, his monthly income and countable cash assets over $50 (except for those who apply for burial services). Some assets are excluded, for example, homestead, one vehicle, household and personal goods.

What is the purpose of the DHS-1514?

The Form DHS-1514 is an application for State Emergency Relief (SER) that covers the following services:

  • Relocation payments to eliminate or avoid homelessness;
  • Mortgage, insurance or property tax payment, to stop forfeiture, foreclosure or tax sale;
  • Limited home repairs;
  • Electric and utility bills, home heating; and
  • Burial costs.

What documents must accompany the Form DHS-1514?

The applicant must attach documents confirming the circumstances that forced him to apply for assistance.

When is the DHS-1514 due?

An application for burial assistance must be made no later than 10 business days after the burial, cremation or donation takes place.

What information should be provided?

The applicant provides the following information:

  • Household address and contact information;
  • Information about home heating;
  • Emergency need (the applicant should check the respective box and specify the amount he needs);
  • Household vehicles;
  • Household assets;
  • Household income;
  • Current housing expenses;
  • Household information for the past six months (number of people in home, total monthly income, rent/mortgage amount, heat, electricity, water, sewer and cooking gas);
  • Home expenses.

Where do I send the DHS-1514?

You can submit your application to the MD HHS office or apply online at https://www.michigan.gov/mdhhs/

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Eligibility Requirements for State Emergency Relief (SER) The emergency must threaten health and safety. The emergency must not have been caused by the individual or family seeking assistance. The emergency must be resolved by the assistance payment and must be one that is not likely to arise again.
To qualify for State Emergency Relief, you must meet a number of requirements. Apply online using MI Bridges.Eligibility. HouseholdMonthly Income*Non-Cash Asset LimitOne$445$1,750Two$500$3,000Three$625$3,000
The State Emergency Relief program provides assistance for energy-related expenses such as heating fuel, electricity and home repairs.
The State Emergency Relief program provides assistance for energy-related expenses such as heating fuel, electricity and home repairs.
State Emergency Relief (SER) will make a one-time annual (once per year) payment to prevent shut-offs, or restore heat, electric, or water service.​SER Income Limits for Energy Assistance. Household SizeMonthly Income LimitFive$3377Six$38725 more rows • Jul 10, 2018
One way to apply is online through the MDHHS website, MI Bridges. However, if you need immediate help you can also apply in person at your local MDHHS office. Your local MDHHS office will give you an application form, but it may be easier to print an application form and fill it out completely before going to MDHHS.

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MI DHS-1514 is a form used by the Michigan Department of Health and Human Services (MDHHS) for the reporting and verification of income and asset information for individuals applying for public assistance programs.
Individuals applying for public assistance programs such as the Michigan Medicaid program, food assistance, or cash assistance may be required to file MI DHS-1514 to provide necessary financial information.
To fill out MI DHS-1514, individuals should carefully read the instructions provided with the form, accurately provide their income and asset information, and ensure all required fields are completed before submitting it to the MDHHS.
The purpose of MI DHS-1514 is to collect and verify income and asset information to determine eligibility for various public assistance programs and ensure that resources are allocated appropriately.
The information that must be reported on MI DHS-1514 includes sources of income, amounts of income, types of assets owned, and any relevant financial details that impact eligibility for assistance programs.
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