1. Read the application form carefully and answer each question completely.

2. If you need help completing or understanding the form, contact your local Department of Social Services office.  If you would like an interview, you may request one.

3. Provide proof of income, insurance,  day care or child support expenses (copies of these documents are acceptable). Proof of identity and citizenship is also required for individuals requesting medical assistance (original documents required).

4. Sign and date the application form. (If two parents are in the home, both must sign.)

5. Mail, fax or take the application form to your local Social Services Office. A decision will be made within 45 days from the date your application is received.

When completing the application, keep the following in mind that:

• If a member of your family receives Social Security income, DO NOT count them in the family size and DO NOT count their income.
• If living with a parent or other adult caretaker, the earnings of a child (under age 19) are not counted.
• Most student loans or grants are not counted as income.
• The start date of medical coverage depends on the date the application is received by the Department of Social Services in your county.
• Medical coverage may go back three months prior to the application date.
• Send proof of all income and expenses from the last 30 days along with the application. Also, send proof of expenses for child support paid and child care paid while working.
• The fifth paycheck, if paid weekly, or the third paycheck, if paid every other week, is NOT counted.

If you need assistance with the application or have questions, contact your local DSS office. For more information, you can also call 1-800-305-3064.

For more information on CHIP, click here.