Get WA DSHS 14-078 2020-2024

DSHS 14-078 REV. 01/2018 Page 1 Immigration Status and Social Security Numbers You may get assistance for some people you live with even if others you live with can t because of their household members may be verified by USCIS formerly known as INS. See www. dshs. wa.gov for locations. Mail your review to one of the following DSHS CSD-Customer Service Center Home and Community Services Long Term Care Services PO Box 11699 PO Box 45826 Tacoma WA 98411-6699 Olympia WA 98504-5826 You can fill out this review online at www. Eligibility Review If you need help reading or completing this form please ask us for help* Keep this page for your records. How do I apply for cash or food assistance You can start the process now by submitting this review at a community services office. It must have your name address and signature or the signature of your authorized representative. You can file your review now even if it only contains these three items. You may get more benefits or get them sooner if you complete and give us your review and any other information we ask for as soon as you can* You can take your review to a local office or fax to 1-888-338-7410. washingtonconnection*org This Eligibility Review form can only be used to renew coverage for the Washington Apple Health programs listed on this form* For other health care coverage you must apply either online at www. wahealthplanfinder. org by calling 1-855-923-4633 or by using the HCA Application for Health Care Coverage HCA 18-001. How soon can I receive help with food and cash If you need food assistance right away fill in Questions 1 through 14 and take this form to your local office. We decide if you are eligible for food assistance within 7 days if you show proof of your identity and meet eligibility rules. We issue benefits by the day after we decide you are eligible. Food assistance usually starts the day we receive your application* Cash assistance usually starts the day we have all the information to decide you are eligible. We must decide if you are eligible for Food Assistance within 30 days of the date you submit your application* If you are submitting your application from an institution the start date is the date of your release or discharge. If you re applying for Food Assistance and other programs We must follow the SNAP rules for processing your application* This includes processing the application within time limits issuing proper notices and advising you of your administrative rights. We cannot deny your Food Assistance just because your application for other assistance programs was denied* Civil Rights In accordance with Federal civil rights law and U*S* Department of Agriculture USDA civil rights regulations and policies the USDA its Agencies offices and employees and institutions participating in or administering USDA programs are prohibited from discriminating based on race color national origin religion sex gender identity including gender expression sexual orientation disability age marital status family / parental status income derived from a public assistance program political beliefs or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA not all bases apply to all programs.