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Click ‘Get Form’ to open the Arkansas Department of Human Services Long Term Care Application for Assistance in the editor.
Begin by indicating whether you are a resident of Arkansas. Select 'Yes' or 'No' in the designated field.
Fill in your full name, race, and sex in the provided fields. Ensure accuracy as this information is crucial for processing your application.
Enter your current address, including street, city, state, zip code, and county. If applicable, provide your former address as well.
Indicate your age category by selecting from options such as '65 years of age or older', 'Blind', or 'Disabled'.
Complete sections regarding income sources for yourself and your spouse if applicable. Check 'Yes' or 'No' for each source and provide amounts and frequency.
Review all sections carefully before submitting to ensure all required information is complete and accurate.

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