Anyone who is 60 or older or gets benefits for a disability can submit out-of-pocket medical expenses to DTA. Please complete the entire form. Only write down information you have. We will tell you if we need more information. Please use a new form for each person in your SNAP case who qualifies. If you need more space, attach a sheet of paper.
Log in links for this page
- This page, Out-of-Pocket Medical Expenses Form, is offered by
- Department of Transitional Assistance