Help applying for 3SquaresVT, Essential Person, Fuel Assistance & Reach Up.
AHS Document Uploader
Use the uploader to send us documents securely — from your computer, phone or tablet. This includes copies of things like immigration documents, pay stubs, and bills.
Follow the steps in the Uploader Instructions.
Forms You May Need To Complete
- Form 120 - 3SquaresVT & Long Term Care Medicaid Out-of-Pocket Medical Expenses
- Form 137 - Child & Medical Support Authorization/ Application for OCS Services
- Form 139AP - Alternate Payee Permission Form
- Form 139AR - Alternate Reporter Request
- Form 139REP - Authorized Representative Form
- Form 200 - Change Report
- Form 201DD - Direct Deposit Request
- Form 202H - Shelter Expense Statement
- Form 204B - Business Income and Expenses Sole Proprietorship
- 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
Organizations That Can Help You Apply
- Call ESD's Benefits Service Center at 1-800-479-6151 — (M-TH from 8AM to 6PM and FRIDAY from 8AM to 4:15PM)
- Visit your local ESD District Office
- Contact other organizations that can help