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Assistance Application (DHS-1171)

Note: A link is available below to view and print the Assistance Application.

The State of Michigan Department of Human Services (DHS) has programs to help you and/or your household (everyone living in your home) with food, medical care, child care, cash and emergencies. We can also tell you about other programs and resources that may help meet your needs. We look forward to helping you and your household.

The DHS-1171 is a packet containing an application for assistance, an information booklet and a filing form. The entire assistance application must be completed in order to receive help from DHS. If you cannot finish the entire assistance application right away, you may complete the Filing Form and return it to the DHS office in your area to protect your application date. The date DHS receives your filing form or assistance application may affect the date your benefits start.

The information booklet contains information about various programs. Each person applying for help should read about the programs and other resources available and how to apply for and receive help. It is important to read the sections: Things You Must Do, Important Things to Know, Repay Agreements, Information About Your Household That Will Be Shared. The person signing the application will be asked to certify they have received a copy and reviewed the information booklet and agree with these sections.

Information: Michigan Assistance and Referral Service (MARS) can help you find out if you may be eligible for the programs offered by the State of Michigan. To find out if you may be eligible, click: MARS to begin the screening tool.

View and the application packet using the links below. The application may be filled out online but you must print it before taking the completed application to the DHS office closest to you.




Related Documents
DHS 1171 Information Booklet, Assistance Application and Filing Form - 2975090 bytes PDF icon
DHS-1171 Filing Form - 332459 bytes PDF icon
DHS-1171 Information Booklet - 585132 bytes PDF icon
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