W 137a 2025

1. Click ‘Get Form’ to open the W-137A in the editor.
2. Begin by entering the date, case name, case number, caseload, center, and worker telephone number at the top of the form.
3. In Section I, specify the type of emergency assistance you are requesting and provide a detailed reason for your request.
4. Move to Section II and check off any additional allowances you are requesting for special needs, such as back rent or utility service restoration.
5. Fill in your new address and any related moving expenses in the designated fields under Section II.
6. In Section III, indicate any supportive services needed for work activities by checking appropriate boxes.
7. If applicable, add individuals to your Cash Assistance case in Section IV by providing their names and relevant details.
8. Finally, sign and date the form at the bottom before submitting it through our platform.

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