All Programs
Online Application
To apply for benefits and services online, visit My Maine Connection. Once there, you can:
- Apply for services
- Complete recertifications
- Review case information
- Submit changes or
- View your benefit history for the past 12 months
SNAP, TANF, or MaineCare Application (PDF)
Use this application if you would like to apply for:
- The Supplemental Nutrition Assistance Program (SNAP)
- Temporary Assistance for Needy Families (TANF) or
- MaineCare Programs
Forms
Authorization to Release Information (PDF)
This form allows DHHS to release or obtain a participant's medical, billing or other confidential records to or from another provider/agency.
Authorized Representative (PDF)
To appoint an authorized representative to act on your behalf with DHHS.
MaineCare
Applications
Use this application if you would like to apply for a MaineCare program, including:
- State Supplement
- Medicare Savings Program (Buy-In)
- Family Planning Services and
- Prescription Help (MaineRx & Low-Cost Drugs for the Elderly)
Long Term Care Application (PDF)
Use this application if you’d like to apply for assistance with the cost of medical services for individuals in a:
- Nursing facility
- Residential care facility or
- Receiving/seeking in home nursing services
Private Health Insurance Program (PHIP) Application (PDF)
Use this application if you are MaineCare member seeking help paying for private health insurance premiums.
COVID-19 Coverage for Uninsured Individuals Application (PDF)
Use this application if you would like to apply for coverage of COVID-19 testing, diagnosis, vaccination, and treatment.
Forms
MaineCare Disability Determination (PDF)
Complete this form if you would like to request a disability determination for MaineCare services.
Long Term Care Personal Support Services Agreement (Word) | also as PDF
SNAP
Applications
Forms
Community College Verification Form (PDF)
Use this form to verify enrollment in certain community college programs that qualify recipients for exemption from SNAP Ineligible Student rules.
SNAP Group Home Screening Form and Fact Sheet (PDF)
Use this form to help determine if residents of a group home you administer may be eligible for SNAP Benefits.
SNAP Changes to Existing Group Homes (PDF)
Use this form to report changes to the address or licensing of a SNAP approved group home.
SNAP Loss and Replacement (PDF)
Use this form to report a loss of food purchased with SNAP benefits if the loss was the result of a fire, flood, power outage, appliance failure, or other household misfortune. The report must be made within 10 days of the loss. You may also report the loss by e-mailing farmington.dhhs@maine.gov or calling 1 (800) 442-6003. A completed form will still be required.
TANF
Applications
Transitional Child Care (TCC) Application (PDF)
Use this application if you are a former TANF recipient and are applying for childcare assistance.
Transitional Transportations (TT) Application (PDF)
Use this application to apply for work related transportation assistance.
Emergency Assistance (EA) Application (PDF)
Use this application to apply for Emergency Assistance. Learn more about Emergency Assistance here.
Forms
ASPIRE/TANF Family Contract (PDF)
Complete this form when applying for TANF or Parents as Scholars (PaS)
HOPE
Applications
Higher Opportunity for Pathways to Employment (HOPE) Application (PDF)
Use this application if you would like to apply for the HOPE program and learn more information.