Application Information:

·         To be considered for the program, complete and submit either an Application for Assistance (if you would like to be considered for this and several other assistance programs) or an Application for Health Care Coverage (if you would like to be considered for only health care coverage) to your county social service office or to the ND Department of Human Services.

      You may complete an online application which will be electronically sent to your county social service office, who will determine your qualification for programs.

           A face-to-face interview is not required.

To speed up the processing of your application, turn in verifications of the following items with your application. Your county social services worker may be able to help you obtain these things if needed.

Verification of Alien or Citizenship Status such as (original documents are required):

• Resident Alien Card (Form I-551)

• Employment Authorization Card (Form I-688A)

• Temporary Resident Card (Form I-688)

• Arrival-Departure Record (Form I-94)

You will be asked to provide information about the citizenship or immigration status for all persons for whom you want to receive assistance. If any of these persons do not want to give information about their citizenship or immigration status, they will not be eligible for benefits. Other household members may still get benefits if they are otherwise eligible. We will not share alien or citizenship information about non-applicants with the United States Citizenship and Immigration Service (USCIS).

Verification of expenses such as:

• Child/Dependent Care

• Court Ordered Payments (Child Support, Health Insurance Premiums, Other Support)

• Medical or Health Insurance Premiums

Verification of income such as:

• Bonuses

• Child Support

• Commissions

• Lease Income

• Money from Friends, Relatives or Others

• Pay (Pay Stubs or Employer Statement)

• Pension/Retirement Benefits

• Rental Income

• Self-Employment Income

• Social Security Benefits

• Spousal Support

• SSI

• Unemployment Benefits

• Veterans’/Military Benefits

• Workers Compensation

Verification of other information such as:

• Identity (Birth Certificate, Driver’s License, Work or School ID - original documents required)

• Age (Birth Certificate, Driver’s License)

• Residence (Rent Receipts, Utility Bills, Lease)

• Social Security Numbers

• Verification of Pregnancy (Doctor’s statement of due date)