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 — (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
Document Uploader
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 218EC – Change in Employment Verification
- Form 218ET - End of Employment Verification