Enable sound
Check Your MISSOURI Benefits Here
Check Your KANSAS Benefits Here
Universal Assistance Intake Form
1. Select All Assistance Needed
Select All Services You Need
2. Select All Qualifying Benefits You Have
Select all benefits you have
3. First and Last Name
*
4. Date of birth: (Tip: Tap on the year 1st)
*
5. Social Security Number
Address
6. Full Address( Include Apt #, City, State, Zip)
City
State
Postal code
7. Contact Number To Reach You:
8. Email:
9. How did you hear about us?
Document Page
If you have any of these documents available please enter them here, otherwise skip this section.
Award Letter (Foodstamps, Medicaid, SSI, Disability, Social Security(Retirement), Utility Bill
Award Letter or Utility Bill
State ID (Un-expired)
State ID
Birth Certificate
Birth Certificate
Social Security Card
Social Security Card
Additional Pic1
Additional Pic1
Additional Pic2
Additional Pic2
Additional Pic3
Additional Pic3