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) including Parents as Scholars (PaS)
- MaineCare Programs
- Emergency Assistance
- Alternative Aid, or
- TANF related Child Care
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)
- COVID Testing & Treatment for Uninsured Individuals
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.
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
SUN Bucks
Applications
Use this application if you would like to apply for SUN Bucks, a federal summer grocery benefit that provides a one-time payment of $120 per eligible school-aged child to help families purchase nutritious food when school is out.
Most eligible children are automatically enrolled and do not need to complete an application. Automatic enrollment is based on participation in programs like SNAP, TANF, FDPIR, or MaineCare (with income under 185% of the federal poverty level); being individually certified for federal free or reduced price meal benefits through their school; or being homeless, in foster care, or part of a migrant family. Families that do not receive an automatic enrollment notice by June 15, but believe their child qualifies, are encouraged to apply manually. Applications must be submitted by August 15, to be considered for the current summer’s benefits.
Forms
SNAP
Applications
Forms
Replacement
SNAP Loss and Replacement (Fillable 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 submit the form by uploading it to MyMaineConnection.gov, e-mailing it to Farmington.DHHS@Maine.gov, mailing it to DHHS, OFI Farmington District Office, 114 Corn Shop Ln., Farmington, ME 04938, or dropping it at your local office. You may also report the loss by e-mailing farmington.dhhs@maine.govor calling
ABAWD
Medical and Behavioral Health Verification Form (PDF)
Use this form to verify a medical exemption from ABAWD work requirements. Exemptions include regular participation in substance use disorder treatment, or not being medically able to work 30 or more hours per week. The form must be completed by a licensed provider.
Use this form to verify sufficient hours volunteering to meet the ABAWD work requirement.
Students
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.
Group Homes
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.
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).
Use this form as a way to verify Good Cause related to domestic violence or sexual assault for the TANF and PaS programs.
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.