NOTICE

The best way to protect yourself against EBT theft is to call 1-888-328-2666 to change your PIN number before the start of each month.

Starting May 22, the Manchester Resource Center will reopen at 699 Middle Turnpike E., Manchester.  

Applications and Forms

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  • W-1226S

    Proof of Food Loss Form - Spanish

  • W-300MED

    W-300MED - For Medicaid for the Employed Disabled - Rev. 12-19

  • W-300SA

    W-300SA - Medical Report For SAGA Cash Benefits - Rev.12-19

  • W-300T19

    W-300T19 - Medical Report For Title XIX Disability Determination - Rev.12-19

  • W-650

    W-650 - Authorization for Reimbursement of Interim Assistance - Rev. 09/10

  • W-650S

    W-650S - Autorización para Reembolso de Asistencia Interina - Rev. 09/10

  • W-675

    W-675 - Report Form For Protective Services For The Elderly - Rev. 06/23

  • W-682

    W-682 - DIRECT DEPOSIT AUTHORIZATION FORM - Rev. 1-23

  • W-682S

    W-682S - FORMULARIO DE AUTORIZACIÓN DE DEPÓSITO DIRECTO - Rev. 1-23

  • W-944

    W-944 - Notice of Action - Rev. 05-23

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