Help applying for 3SquaresVT, Essential Person, Fuel Assistance & Reach Up.
Organizations That Can Help You Apply
- Call ESD's Benefits Service Center at 1-800-479-6151 — Monday to Friday, 8:00AM to 6:15PM until further notice.
- Visit your local ESD District Office
- Contact other organizations that can help
Once you apply, we may ask you to send documents needed to determine your eligibility. Use our Document Uploader to send documents securely — from your computer, phone or tablet.
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 218ET - End of Employment Verification