Program Summary

Selected Cash Assistance Programs

Household MemberHead of HouseholdInitial AmountAmount/Per Month
[field-value][A. Name][Amount][Amount]

Selected Food Assistance Programs

Household MemberHead of HouseholdInitial AmountAmount/Per Month
[field-value][A. Name][Amount][Amount]

Selected Medical Assistance Programs

ProgramHousehold Member
[Benefit Sample][field-value]

Selected Children's Health Insurance Program Premiums

ProgramHousehold Member
[Benefit Sample][field-value]

Applications Denied

ProgramReasonApplicationApplication Date
[field-value][field-value][field-value][Date]

Confirm Selection

Select 'Authorize' to confirm these eligibility decisions.

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