Supplemental Forms

Additional Forms You May Need To Complete
Form 120 - 3SquaresVT/3SquaresVT in a SNAP Out-of-Pocket Medical Expenses
Form 137 - Child & Medical Support Authorization/ Application for OCS Service
Form 139AP - Alternate Payee Permission Form
Form 139AR - Alternate Reporter Request
Form 139REP - Authorized Representative Form
Form 200 - Change Report
Form 201A - Agreement to Report Changes
Form 201DD - Direct Deposit Request
Form 202H - Shelter Expense Statement
Form 202IR - Interim Report
Form 204B - Business Income and Expenses Sole Proprietorship
Form 207 - Protective Payment Agreement
Form 210A - Training and Employment Medical Reports
Form 216 - Student Self Declaration of Financial Aid and Expenses
Form 218 - Income Verification
Form 218E - Employment Information
Form 218EC – Change in Employment Verification
Form 218ET - End of Employment Verification
Form 218WFV - Workfare Verification Form (fillable)
Form 271 - Attestation of Loss and Request For Replacement 3SquaresVT Benefits
Form 614FDP - Initial Family Development Plan (fillable)

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