Form Dhs-2 - Application Forassistance - Rhode Island Department Of Human Services Page 8
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38DHS-2 Rev. 10-14
Page 4
1
.
List everyone who lives in your home now
(
If you are applying for SNAP, list everyone who lives in your home now, even if they do not want assistance. If you applying for any other
program, enter the information below only for the applicant, his/her, spouse and any dependents. If you are applying for the Katie Beckett
Program, enter the information below for the child only).
HOUSEHOLD
Assistance asked for
Date
Middle
Relation
of
MA
MA
Katie
Last Name
First
Initial
to you
Birth
SNAP
RIW
LTSS
ABD
GPA
CCAP
MPP
SSP
Beckett
None
1
___/____/____
2
___/____/____
3
___/____/____
4
___/____/____
5
___/____/____
6
___/____/____
7
___/____/____
8
___/____/____
9
___/____/____
If there are more people in your household, please list them on page 26 marked, “for
client use only”.
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