Here you will find a collection of the most common Department of Transitional Assistance (DTA) documents and forms, as well as outreach materials.
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- Department of Transitional Assistance
Resource DTA Documents & Forms
|Organization:||Department of Transitional Assistance|
|Date published:||March 17, 2022|
Most common forms, document and outreach materials.
Most forms are available online here or on DTA Connect.
Learn how to submit documents, apply for benefits, request an EBT card or letter showing the amount of benefits you receive (benefit verification letter), or complete your SNAP recertification or interim report online. If you do not find what you are looking for, call the DTA Assistance Line at (877) 382-2363.
Table of Contents
- SNAP Benefits Applications
- SNAP Benefits Applications for Seniors
- SNAP Work Requirement Medical Report (FSPWR-WP-MED)
- Request to Choose Someone to Be My Authorized Representative
- Other Agency Certification of Shelter and Utility Costs
- SNAP-9B - Request for Replacement SNAP Benefits
- Permission to Share Information Form (PSI)
- Out-of-Pocket Medical Expenses Form
- Application for Funeral and Final Disposition Benefit
- Authorization for reimbursement of interim assistance Initial claim or postelig…
- Direct Deposit form
- EAEDC Medical Provider Statement
- Good Cause Medical Statement
- High School Equivalency (HSE) Test Voucher Request
- Verification of Caring for the Disabled