Completing this Application


On this page, we're asking who is filling out the application.


If you have a friend, family member, staff member, staff person or volunteer at an agency, legal guardian or someone who has power of attorney helping you, just keep going with the application. When you get to the end, you should sign the application.


If you have an authorized representative, we'll ask you a few more questions before you go on to the rest of the application.


We'll ask about how we can get in touch with the authorized representative(AREP). Keep in mind that the form needs to be signed by you, your AREP, and a witness. Once this person becomes your AREP, he or she can sign your application and call the local agency to get information about your case.


If you have a legal guardian, we'll ask how to get in touch with him or her. Your legal guardian must sign this application.  Keep in mind that he or she may need to prove his or her status as a legal guardian.


If someone has power of attorney for you, we'll ask how to get in touch with that person. Keep in mind that the person should sign this application only if he or she has durable power of attorney. We may ask for proof of this person's status after you apply.



Reasonable Accommodation


The term reasonable accommodation means reasonable modifications to the Department’s policies, practices, or procedures that are necessary to allow an individual with a disability to participate meaningfully in the services, benefits, activities, and programs administered by the Department including, but not limited to, alterations in the eligibility and redetermination process that are necessary as a result of the individual’s disability to allow him or her to establish and maintain eligibility notwithstanding his or her disability.  A reasonable modification does not include a waiver of any essential factor of eligibility or modification of the Department’s policies, practices, or procedures that would either fundamentally alter the nature of the program or cause undue fiscal or administrative burden on the Department.


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