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 print the application packet using the link below. Take the completed application to the DHS office closest to you.

• Assistance Application (DHS-1171) including Information Booklet and Filing Form.

• Filing Form only.

• Information Booklet only.

More space may be needed to enter specific information in various sections of the application. Refer to the links below to print any extra sections.

• Section C. Information About You and Your Household - Space for six persons is available in the application. Enter numbers seven and above in the space provided on this page.

• Section D. Household Members Under Age 22 - Use this page to enter information about the parents of persons under 22 when there are more than four living in the home.

• Section E. Medical Information - Space is limited on this page. Use this page when more space is needed to enter information.

• Section G. Asset Information - Use this page when information is needed for more than four types of assets.

• Section H. Vehicle Information - Use this page when you have more than three vehicles to report (includes car, truck, boat, camper/trailer, motorcycle, RV, other vehicle.

• Section I. Migrant or Seasonal Farmworker Income - Space is limited on this page. Use this page when more space is needed to enter information.

• Section J. Employment Changes - Space is limited on this page. Use this page when more space is needed to enter information.

• Section K. Self-Employment Income (including odd jobs) - Use this page to enter information for more than two types of self-employment income or more than two persons living in the home who are self-employed.

• Section L. Employment Income - Use this page to enter information when more than two jobs are held by the persons living in your household.

• Section M. Other Income - Use this page when information is needed for more than three types of other income.

• Section N. Disability Benefits - Use this page when disability benefit information is needed for more than three persons or multiple persons/benefits were applied for, been denied, appealed or a hearing requested for disability benefits.

• Section O. Dependent Care Expenses and Court Ordered Support - Use this page when more than three spaces are needed.

• Section P. Child Care Expenses - Use this page when more than seven spaces are needed to report child(ren) needing care or multiple providers for the same child(ren).

• Section Q. Medical Expenses - Use this page when information is needed for more than four types of medical expenses.

• Section U. State of Michigan Voter Registration Application - Use this page if you are not already registered to vote at your current address and would like to do so.