Dhs form ia 54a 2025

1. Click ‘Get Form’ to open the dhs form ia 54a in the editor.
2. Begin by entering your Case Number and County Number at the top of the form. This information is crucial for identifying your application.
3. Fill in your Worker Name, ensuring that all details are accurate to avoid any processing delays.
4. Complete the Household Members section by listing all individuals receiving benefits with you. Include their names, Social Security Numbers, ages, and educational backgrounds.
5. In the Income section, provide detailed information about all sources of income for each household member. Attach proof such as pay stubs or tax forms as required.
6. Review and complete the Expenses section if applicable, detailing any childcare costs or medical expenses not covered by insurance.
7. Sign and date page 4 of the form to certify that all information provided is correct. If someone assisted you in completing the form, ensure they sign as well.
8. Finally, submit your completed form along with any required documentation either by mail or in person at your local DHS office.

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