Daas 8191-2026

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The document is a Special Assistance Re-enrollment Information Notice from the Department of Social Services (DSS) that outlines the process for reviewing eligibility for the State/County Special Assistance program. It requires recipients to report their income and assets, provides information on health insurance, and details the rights and responsibilities of applicants and recipients. The form must be completed and returned by a specified date to ensure continued benefits.

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Click ‘Get Form’ to open the daas 8191 in the editor.
Begin by filling in your DSS Name and Address at the top of the form. Ensure that all details are accurate for proper processing.
In the 'Case Name' section, enter your name as it appears on official documents. Include the Mail Date and NCF Case ID for reference.
Complete the recipient information, including names and addresses of any authorized representatives if applicable.
Report your income by filling out the provided chart. Indicate both earned and unearned income types, ensuring to specify amounts and frequency.
Next, disclose any assets you own in the designated section. If you receive SSI, skip this part.
Indicate your health insurance status and provide details about your coverage if applicable.
Finally, review all entries for accuracy before signing at the bottom of the form to certify that all information is true.

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Versions	Form popularity	Fillable & printable
2015	4.8 Satisfied (80 Votes)
2015	4 Satisfied (20 Votes)

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