Okdhs Form – Fill Out and Use This PDF

The OKDHS Form, also known as Form 08MP001E (PS-1), serves as a comprehensive request for benefits ranging from Supplemental Nutrition Assistance Program (SNAP) and Health Care Coverage to Child Care Subsidy and Temporary Assistance for Needy Families (TANF). It is a critical step for individuals and families seeking assistance to fill out this form accurately and provide the necessary information to qualify for various welfare programs. To get started on receiving the support you need, click the button below to fill out the form.

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Okdhs Form PDF Details

Navigating the maze of social assistance can often feel overwhelming, particularly when facing the paperwork required to access much-needed benefits. Among the most crucial documents in this process is the Oklahoma Department of Human Services (OKDHS) form, a comprehensive tool designed for individuals and families seeking support through various state programs. This form, formally labeled PS1, acts as a gateway to a range of services including the Supplemental Nutrition Assistance Program (SNAP), child care subsidies, SoonerCare (Medicaid), State Supplemental Payment (SSP), family planning services, and Temporary Assistance for Needy Families (TANF), among others. Designed with accessibility in mind, it requires applicants to provide detailed personal and financial information, ensuring they are matched with the benefits best suited to their circumstances. The form also outlines the rights of applicants, such as fair treatment and the ability to request a hearing if necessary, emphasizing the state's commitment to equitable support. Furthermore, it walks applicants through the process, from scheduling interviews to listing the documents needed to verify their eligibility. The intricate design of the OKDHS form represents a critical step in connecting Oklahoma residents with the resources they need to thrive.

Question	Answer
Form Name	Okdhs Form
Form Length	6 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	1 min 30 sec
Other names	dhs forms oklahoma, okdhs forms oklahoma, okdhs forms okdhs, oklahoma department of human services forms

Form Preview Example

*PS1 *

Date:	__ _____

Case name:	______________________
Case number:			____________________
County number.		_____________________

Supervisor/worker number: /

Request for Benefits

For use with Forms 08MP002E and 08MP003E _______

What you need to do to get started:

Read the following descriptions and check all of the programs for which you would like to apply. Fill out this form or have someone else fill it out for you.

Program	Description	Apply?

Supplemental Nutrition	Helps buy food. Formerly known as the Food
Assistance Program (SNAP)	Stamp Program.

Child Care Subsidy	Helps pay for care for your child so you can
	work, go to school, or attend training.

Health care coverage -	Helps pay for medical costs for pregnant
SoonerCare (Medicaid)	women and families with children.

	Helps pay for medical costs for people who
	are elderly or disabled.

	Helps pay for nursing care in your home or in
	a nursing home.

	Helps pay Medicare Part A and B premiums.

	State Supplemental Payment (SSP) - gives a
	small cash payment to low-income people
	who are blind, 65 years of age or older, or
	receive Supplemental Security Income (SSI)
	or Social Security disability.

	Family Planning Services - helps pay for birth
	control and family planning services.

Temporary Assistance for	Helps low income families with minor children
Needy Families (TANF)	by providing temporary cash and services.

Form 08MP001E (PS-1) revised 01-1-2012 may continue on next page, page 1 of 6

When you ask for help from OKDHS, you have a right to:

•receive equal treatment regardless of race, color, age, sex, disability, religion, political belief, or national origin; and

•ask for a fair hearing, either orally or in writing, if you disagree with any action taken on your case. Any person you choose may represent you at the hearing.

What to do when you complete the form:

•Sign this form and take, mail, or fax it to the local OKDHS office.

•After you give us this form, we will set up your interview. During your interview, we will help you complete the rest of the application. We will also tell you which benefits you can receive.

Schedule my interview.

Please put an X in the table for the days and times you are available for your interview:

Morning Afternoon

Monday

Tuesday

Wednesday

Thursday

Friday

What you will need to bring to your interview:

•proof of identity, such as driver license or school identification;

•Social Security number or card for everyone who wants benefits;

•proof of citizenship for everyone who wants benefits;

•proof of legal status for anyone who is not a U.S. citizen and wants benefits;

•proof of income for everyone living with you, such as pay stubs or award letters;

•proof of all resources, such as bank accounts, car titles, or land; and

•proof of your need for child care, such as your work or school schedule, and the name of the place you want to use to care for your child.

You may be asked to give more information after your interview. You have the right to refuse to give any or all information. However, if you don't give us the information we need, we may not be able to help you.

How can we contact you?

Name

Mailing address, street or P.O. Box

City

State

Zip

Street address or directions to your home, if different than mailing address

Phone number where you can be reached

Email address

Form 08MP001E (PS-1) revised 1-1-2012 may continue on next page, page 2 of 6

Tell us about everyone who lives in the home starting with the adult head of household.

This person will be the payee. You must check yes or no in the U.S. citizen block and fill in the Social Security number for each person who wants benefits. If there are more than six persons in your household, attach another sheet of paper showing their information.

Person 1. Name of adult head of household

Name at birth, if different from above

Sex

M F

State of birth

Date of birth

County of birth

Mother's maiden name as listed on this person's birth certificate - First, M.I., Last

U.S. citizen		Alien registration number		Social Security number
Yes	No

Marital status		Hispanic or Latino		Relationship to payee
		Yes	No	self

Race - check all that apply
White	Asian	Black or African American
Native Hawaiian or other Pacific Islander			American Indian or Alaskan native

Person 2. Name

Name at birth, if different from above

Sex

M F

State of birth

Date of birth

County of birth

Mother's maiden name as listed on this person's birth certificate - First, M.I., Last

U.S. citizen

Yes No

Hispanic or Latino

Yes No

Alien registration number

Social Security number Marital status

Relationship to spouse of payee

Race - check all that apply
White	Asian	Black or African American
Native Hawaiian or other Pacific Islander			American Indian or Alaskan native

Form 08MP001E (PS-1) revised 1-1-2012 may continue on next page, page 3 of 6

Person 3. Name	Sex
	M F
Name at birth, if different from above	State of birth

Date of birth

County of birth

Mother's maiden name as listed on this person's birth certificate - First, M.I., Last

U.S. citizen		Alien registration number	Social Security number	Marital status
Yes	No
Hispanic or Latino		Relationship to payee	Relationship to spouse of payee
Yes	No
Race - check all that apply
White	Asian	Black or African American
Native Hawaiian or other Pacific Islander			American Indian or Alaskan native

Person 4. Name

Name at birth, if different from above

Sex

M F State of birth

Date of birth

County of birth

Mother's maiden name as listed on this person's birth certificate - First, M.I., Last

U.S. citizen		Alien registration number	Social Security number	Marital status
Yes	No
Hispanic or Latino		Relationship to payee	Relationship to spouse of payee
Yes	No
Race - check all that apply
White	Asian	Black or African American
Native Hawaiian or other Pacific Islander			American Indian or Alaskan native

Person 5. Name

Name at birth, if different from above

Sex

M F State of birth

Date of birth

County of birth

Mother's maiden name as listed on this person's birth certificate - First, M.I., Last

U.S. citizen		Alien registration number	Social Security number	Marital status
Yes	No
Hispanic or Latino		Relationship to payee	Relationship to spouse of payee
Yes	No
Race - check all that apply
White	Asian	Black or African American
Native Hawaiian or other Pacific Islander			American Indian or Alaskan native

Form 08MP001E (PS-1) revised 1-1-2012 may continue on next page, page 4 of 6

Person 6. Name

Name at birth, if different from above

Sex

M F

State of birth

Date of birth

County of birth

Mother's maiden name as listed on this person's birth certificate - First, M.I., Last

U.S. citizen

Yes No

Hispanic or Latino

Yes No

Alien registration number

Relationship to payee

Social Security number Marital status

Relationship to spouse of payee

Race - check all that apply
White	Asian	Black or African American
Native Hawaiian or other Pacific Islander			American Indian or Alaskan native

If you are applying for health benefits, does anyone need medical care today?

Yes

If yes, please check the reason(s) below:

•just got out of the hospital;

•need a prescription;

•pregnant;

•need to see a doctor;

•other

If you need child care:

Are you in danger of losing a job due to a lack of child care?

Yes

Have you made payment arrangements with the child care provider until a decision can

be made on your child care application?			Yes	No
Are you starting a new job? Yes	No	If yes, starting date:

Once you have completed the application and interview, the earliest date you can get help with child care is the date you bring all needed information to your local OKDHS office.

Please answer these questions to see if you can get food benefits within seven calendar days.

1.How much money did you get or will you get

this month from working (total amount before taxes)? $

2.How much other money did you get or will you get

	from all other sources this month (total amount)?	$
3.	How much cash do you have?	$
4.	How much money do you have in bank accounts?	$
5.	How much do you pay for your rent or mortgage?	$
6.	Do you pay the heating or cooling bill where you live?	Yes	No
7.	Are you a seasonal or migrant farm worker?	Yes	No
8.	Does anyone in your household receive tribal food
	commodities?	Yes	No

Form 08MP001E (PS-1) revised 1-1-2012 may continue on next page, page 5 of 6

Households entitled to a decision within seven calendar days regarding their food benefit application are:

•households with less than $150 gross monthly income and liquid resources less than $100;

•households with monthly rent or mortgage and/or utilities which cost more than the combined monthly gross income and liquid resources; and

•destitute migrant or seasonal farm worker households with liquid resources less than $100.

If this describes your household, please stay for an interview or to get an appointment date and time.

Read this information and then you must sign below:

I give OKDHS permission to check the information I gave on this form to make sure it is true.

I understand that the names and Social Security numbers I gave will be used to obtain information from other state and federal agencies.

I give OKDHS permission to share information with other agencies.

Your signature

Today's date

Please give this form to the receptionist or fax or mail it to your local OKDHS office.

OKDHS use only:

Date form was received:	Date screened:
Screened by:

Is the household eligible for expedited food benefits? Yes

Interview date:

Interviewed by:

OKDHS routing information: The original is imaged or filed in the case record. Upon request, a copy is given to the client.

Form 08MP001E (PS-1) revised 1-1-2012 may continue on next page, page 6 of 6

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1. The okdhs forms okdhs usually requires specific information to be entered. Make sure the following blanks are finalized:

okdhslive org forms conclusion process described (stage 1)

2. Now that the previous section is completed, you're ready to put in the required particulars in Health care coverage SoonerCare, Temporary Assistance for Needy, Helps pay for medical costs for, Helps pay for medical costs for, Helps pay for nursing care in your, Helps pay Medicare Part A and B, State Supplemental Payment SSP, and Helps low income families with allowing you to move on further.

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Be extremely mindful while filling out Temporary Assistance for Needy and Helps pay for nursing care in your, since this is the section where most users make some mistakes.

3. This third stage is usually simple - complete all the empty fields in Monday, Tuesday Wednesday, Thursday, Friday, Morning Afternoon, What you will need to bring to, proof of identity such as driver, name of the place you want to use, You may be asked to give more, How can we contact you, and Name Mailing address street or PO in order to complete this process.

Morning Afternoon, You may be asked to give more, and Name Mailing address street or PO inside okdhslive org forms

4. The subsequent section requires your attention in the following parts: Name Mailing address street or PO, Email address, State Zip, City, Form MPE PS revised may continue, and page of. Always fill in all requested information to move further.

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5. As you come near to the completion of your file, you'll find a few more requirements that should be satisfied. Particularly, Date of birth, Sex M State of birth County of, Person Name of adult head of, Social Security number, American Indian or Alaskan native, Black or African American, Asian, Date of birth, Sex M State of birth County of, and Person Name Name at birth if must be filled in.

okdhslive org forms conclusion process detailed (part 5)

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