Applications and Forms

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• HIPAA Authorization for Disclosure of Information W-298S

  HIPAA Authorization for Disclosure of Information W-298S

• HIPAA Authorization for Disclosure of Information W-298

  HIPAA Authorization for Disclosure of Information W-298

• W-1226

  Proof of Food Loss Form

• Bulk Ordering of Forms

  To order bulk quantities of DSS forms, please follow this link to our Forms Requisition Site.

• Request for Exemption from the SNAP Time Limit (W1460S) - Spanish

  Request for Exemption from the SNAP Time Limit (W-1460S) - Spanish - Rev. 10/24

• Application for Benefits (W-1ES) - Spanish

  Application for Benefits (W-1ES) - Spanish - Latest Version

• Request for Exemption from the SNAP Time Limit (W1460) - English

  Request for Exemption from the SNAP Time Limit (W-1460) - English - Rev. 10/24

• Application for Benefits (W-1E) - English

  Application for Benefits (W-1E) - English - Latest Version