NH Department of Health & Human Services (DHHS) Division of Family Assistance (DFA)DFA Form 65 11/01 Rev 3/2011 rev2 3/15Clients Printed NameDateClients Case NumberCLIENT STATEMENT Shelter StatementFraud.

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How to fill out the NH BFA 65 online

The NH BFA 65 form is an important document used by the New Hampshire Department of Health and Human Services. This guide will provide you with clear, step-by-step instructions to help you fill out the form accurately and efficiently online.

Follow the steps to complete the NH BFA 65 form online.

  1. Click the ‘Get Form’ button to access the form and open it in your preferred editor.
  2. Begin by entering your printed name in the designated field. This refers to the name as it appears on official documents.
  3. Next, input the date on which you are filling out the form. Make sure to use the current date.
  4. Fill in your client's case number accurately. This number is crucial for the processing of your application.
  5. In the 'Client Statement' section, provide relevant details in regard to the specific statements listed, such as the Shelter Statement or Fraud Statement. Be clear and concise.
  6. If applicable, indicate whether you are voluntarily withdrawing your application or terminating assistance by selecting the relevant option.
  7. For changes regarding vendor payments, fill out the section about initiating, changing, or removing a vendor payee, specifying the vendor details as needed.
  8. Report any issues regarding lack of adequate child care or loss of employment, if they apply to your situation.
  9. Once all sections are completed, review your entries for accuracy and completeness.
  10. Finally, you will need to sign as the casehead, print your name again, and include the date next to your signature.
  11. After completing the form, follow the instructions to save your changes, download the form for your records, print it, or share it as needed.

Complete your NH BFA 65 form online today for efficient processing.

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