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Download the Application
for Benefits*
The Social Services Application
For Benefits, more commonly known as the ''14 Page Application'' is used when
applying for Medicaid, Food Stamps,Temporary Assistance for Needy Families
(TANF), or General Relief. You may apply for multiple programs using a single
application.
This application consists of 14 pages and has specific instructions for
completion inside the application. Pages 1-7 of this application must be
completed by all applicants no matter what programs are applied for. Pages 8-13
are program specific, therefore, you only need to complete the pages that
pertain to the program you are applying for. Please be sure to give accurate
information and to complete the application in full.
If applying for Medicaid,
please be sure to complete page 13 of the application to assign your rights to
medical support. No matter what program you are applying for, you need to sign
and date page 14 of the application to make it an official document.
For general information on the programs offered by Virginia social services,
please request the Virginia Social Services Temporary Assistance Programs
Information Brochure from the Department of Social Services. This brochure
gives information on the Food Stamp, Temporary Assistance for Needy Families
(TANF), Medicaid, State and Local Hospitalization (SLH), Auxiliary Grants, and
General Relief programs offered by the Virginia Department of Social Services.
You may drop off your completed 14 page application or mail it to the City of
Richmond Department of Social Services at the following address:
Submit Application With Appropriate Materials To:
City of Richmond Department of Social Services
900 E. Marshall Street
Richmond, VA 23219
If you need further instructions, please call (804) 646-7212.
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*Note:
In order to view and print these documents, your
computer must have the Adobe
Acrobat Reader utility installed; if this software
is not installed on your system, you can download it for
free from Adobe.
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