Demo disclaimer

What program(s) is your household applying for today?

To apply for benefits, choose from the programs below. You can select more than one.

Enter your name, date of birth, and anyone you live with. You can add up to four household members.

Your name Date of birth Household members

Answer a few questions about each person.

Race (select all that apply)

Is this person married?

Please answer race and marital status.

Next, you'll answer a few questions about your household.

Please answer every question.

Who does this apply to?

Select at least one person.

Answer this follow-up question.

Please choose Yes or No.

Next, you'll answer a few questions about income.

Please answer every question.

List anyone in your household who is employed now, or has been in the last 30 days.

Please complete all required fields for each job.

List anyone in your household who is self-employed.

Please complete all required fields for each self-employment.

List anyone in your household who has additional income.

Please complete all required fields for each additional income.

Answer the following questions about seasonal work in your household.

Please select who is a seasonal worker and answer all follow-up questions.

Based on your application, the following people need to report 80 hours of work activities in .

Report work activities completed last month:

80 hours of work activities can be a combination of multiple activities. Check all that apply.

Next, you will be asked to review your application.

Here's a summary of what was entered in this application.

Thanks for using this demo. We hope it helped show how our application recommendations and plain-language questions can be implemented.