Applications

Cover sheet and Application for Assistance (DHS-2), 9/2016
[Application for Assistance- Spanish], 9/2016
[Application for Assistance- Portuguese] 9/2016
Use this application to apply for the following programs: RI Works, Supplemental Nutrition Assistance Program, Child Care Assistance Program, General Public Assistance, RI SSI State Supplemental Payment Program, Affordable Care Coverage (includes Medicaid and private health insurance with financial help), Medicaid Long-Term Services and Supports (LTSS), Medicaid health coverage for low-income elders and persons with disabilities, Sherlock Plan, Medicare Premium Payment Program, and Katie Beckett.
Mail the completed application to: Department of Human Services, P.O. Box 8709, Cranston, RI 02920-8787. For more information on these programs, see Programs and Services .

Executive Office of Health and Human Services

Cranston, RI 02920

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State of Rhode Island