Other people living at your address share the costs for food, rent, and utilities. Attach additional pages if needed. 1. CLIENT'S NAME 2. TELEPHONE NUMBER ( 4. STREET ADDRESS ) 3. TOTAL NUMBER OF PERSONS LIVING AT THIS ADDRESS - CITY STATE ZIP CODE 5. Complete the following information for all other ADULTS (age 18 and over) who live at your address: NAME SOCIAL SECURITY NUMBER SHARES FOOD COST RELATIONSHIP TO ME (SON, MOTHER, FRIEND, ETC.) BIRTHDATE YES COOKS OR EATS MEALS WITH ME.
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How to fill out the WA DSHS 14-393 online
The WA DSHS 14-393 form, known as the Statement of Shared Living Arrangement, is a crucial document that outlines how individuals at a shared address manage their living expenses. This guide will walk you through filling out the form online in a clear and supportive manner.
Follow the steps to effectively complete the WA DSHS 14-393 form.
- Press the ‘Get Form’ button to access the WA DSHS 14-393 form and open it in the online editor.
- Begin by entering your name in the 'Client's Name' field. Ensure that the spelling is accurate and matches your identification documents.
- Complete the 'Telephone Number' section by entering a valid phone number where you can be reached.
- Provide the 'Street Address' along with the 'City,' 'State,' and 'ZIP Code' to accurately identify your residential location.
- Indicate the total number of people living at your address in the corresponding field.
- For all other adults (18 and over) living at your address, fill out their name, social security number, relationship to you, and birthdate. Specify whether they share food costs and if they cook or eat meals with you.
- For children under 18 at your residence, provide each child's name, social security number, and birthdate. Clarify their relationship to the other adults living at the address.
- In the 'Expense Information' section, state your current monthly rent and indicate if there are additional costs for utilities like electrical, water, and garbage that are not included in the rent.
- Detail how you and the other adults allocate your monthly expenses by listing each person’s contributions next to the respective costs for rent, heating/cooling, electricity, water, garbage, and telephone.
- All individuals aged 18 and over must sign and date the form to affirm the accuracy of the information provided.
- Once all fields are completed, you can save changes, download, print, or share the form as necessary.
Complete the WA DSHS 14-393 form online today to manage your shared living arrangement effectively.
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What does the Washington State Department of Social and Health Services do?
The Washington State Department of Social and Health Services (DSHS) provides a wide range of services including financial assistance, food programs, and child welfare. DSHS aims to enhance individuals' quality of life by connecting them with necessary resources. By leveraging programs such as WA DSHS 14-393, many residents can access crucial services that promote self-sufficiency and stability.
How to apply for DSHS benefits in Washington?
To apply for benefits through DSHS, you can complete an online application on their official website, making the process quick and convenient. Additionally, you can visit a local DSHS office to receive personal assistance with your application. Utilizing resources like WA DSHS 14-393 ensures you have the support needed to navigate the application process effectively.
What does the Washington State Department of Health do?
The Washington State Department of Health works to protect and improve the health of communities throughout the state. This department oversees public health programs, disease prevention, and health education initiatives. Collaboratively, both the Department of Health and the DSHS aim to enhance the overall well-being of Washington residents.
What is the DSHS stop work form for Washington State?
The DSHS stop work form is used by individuals who wish to report that they are no longer working or have reduced their work hours. Submitting this form is essential for updating your benefit status with WA DSHS 14-393. It helps ensure that you receive the correct amount of assistance based on your current employment situation.
How to apply for TANF in Washington?
To apply for Temporary Assistance for Needy Families (TANF) in Washington, you need to complete an application through DSHS. You can apply online by visiting the DSHS website or by calling your local office for assistance. Once you submit your application, DSHS will review your information, and if approved, you will receive benefits to help support your family.
What does DSHS do in Washington State?
The Washington State Department of Social and Health Services (DSHS) plays a crucial role in providing social services to residents. DSHS helps individuals and families access essential benefits, such as food assistance, financial support, and healthcare services. Through programs like WA DSHS 14-393, DSHS aims to ensure that vulnerable populations receive the support they need to achieve self-sufficiency.
How do I apply for DSHS in Washington State?
Applying for DSHS in Washington State involves visiting their website and completing an online application or reaching out in person at a local office. Be ready with necessary information about your household, income, and needs during the application process. Adhering to the protocols defined in WA DSHS 14-393 will support an efficient evaluation of your application.
How do I report changes to DSHS in Washington State?
You can report changes to DSHS in Washington State by logging into your DSHS account or by calling their customer service. Provide detailed information about the changes you wish to report, whether they concern income, residency, or other significant factors. Staying updated with your information is essential for adherence to WA DSHS 14-393.
How do I submit documents to DSHS Washington State?
Submitting documents to DSHS Washington State can be done through their online submission portal or via mail. If you choose to submit documents online, scan your documents and upload them directly through your account. This approach meets the requirements outlined in WA DSHS 14-393, facilitating a quicker review of your information.
How do I report a change on Washington Health Plan Finder?
To report a change on the Washington Health Plan Finder, log into your account and navigate to the 'Report a Change' section. You can update details such as income, household size, or health insurance coverage easily. This process helps you stay compliant with WA DSHS 14-393, ensuring you receive the appropriate coverage and benefits.
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