APPLICATION FOR TEMPORARY ASSISTANCE CASH BENEFITS

Temporary Assistance (TA) provides cash benefits to eligible families with children to help pay for basic needs.

  • By completing this application, you are applying for TA as a caretaker of a child
  • YOU MAY BE ELIGIBLE FOR CHILD CARE SUBSIDY TA recipients must participate in Work Requirements unless exempt. You can qualify for Child Care if you are participating. If you need Child Care you can apply by going to: https://dss.mo.gov/fsd/child-care.htm 
    • To apply online, click “Apply Online”
    • To print the paper application, click “Paper Application” (you can complete it online then print it, or print it and complete it by hand)

Need help with your application?

  • Call the Family Support Division (FSD) Call Center at 1-855-373-4636, or
  • Refer to Section 1 to find your local FSD Resource Center for in-person help
  • Need help in a language other than English?
    • Tell the customer service representative the language you need, or
    • See Section 7 “Language” for more information.
  • TTY users
    • Call 1-800-735-2966, or
    • Call Relay Missouri at 711
  • See “Other Helpful Numbers” in Section 1.

En español (Spanish) | ¿Necesita ayuda con su solicitud?

  • Llame al Centro de Atención de la División de Apoyo a la Familia (FSD) al 1-855-373-4636, o;
  • Consulte la sección 1 para localizar el Centro de Recursos de la FSD más cercano.
  • ¿Necesita ayuda en un idioma diferente al inglés?
    • Dígale al representante de servicio al cliente el idioma que usted necesita, o;
    • Consulte la Sección 7 “Idioma” (página 9) para obtener más información.
  • Usuario de TTY:
    • Llame al 1-800-735-2966, o;
    • Llame al servicio de Relay Missouri al 711.
  • Consulte “Otros números útiles” en la sección 1.

En bosnio (Bosnian) - Da li trebate pomoć sa Vašom aplikacijom?

  • Pozovite Centar za podršku porodici (FSD) na broj 1-855-373-4636 ili
  • Pogledajte odjeljak 1 na 4-oj stranici gdje možete pronaći vaš lokalni FSD Resurs Centar (Resource Center)
  • Da li Vam je potrebna pomoć na jeziku koji nije engleski?
    • Recite predstavniku servisa za kupce koji Vam je jezik potreban ili 
    • Pogledajte odjeljak 7 na 9-oj stranici gdje piše „Jezik”, za više informacija.
  • TTY korisnici
    • Pozovite 1-800-735-2966 ili
    • Pozovite Relay Missouri na 711
  • Također možete vidjeti i “Druge korisne brojeve” u odjeljku 1 na 4-oj stranici

En vietnamita (Vietnamese) - Quý vị cần được trợ giúp về việc hoàn thành mẫu đơn yêu cầu?

  • Vui lòng gọi đến Trung tâm Tiếp nhận Cuộc gọi của Ban Hỗ trợ Gia đình (Family Support Division (FSD)) theo số 1-855-373-4636 hoặc
  • Vui lòng xem Mục 1 để tìm Trung tâm Tài nguyên của FSD nơi Quý vị cư ngụ.
  • Quý vị cần được trợ giúp bằng một ngôn ngữ khác ngoài Tiếng Anh?
    • Xin hãy nói chuyện với đại diện dịch vụ khách hàng về ngôn ngữ Quý vị cần hoặc
    • Vui lòng xem Mục 7 “Ngôn ngữ” để biết thêm thông tin chi tiết.
  • Người dùng TTY
    • Vui lòng gọi đến số 1-800-735-2966 hoặc
    • Gọi cho Đường dây Chuyển tiếp Cuộc gọi của Tiểu bang Missouri theo số 711
    • Vui lòng xem “Các Số Hữu Ích Khác” trong Mục 38.

Please read and complete the “TA Orientation” Section 26, and the “Personal Responsibility Plan” Section 27. If they are not completed, this will delay the processing of your application and may cause your application to be REJECTED.

YOU MUST - Read and complete pages and you MUST SIGN “Your Agreement and Signature” Section 35.

PAPERWORK NEEDED - Many sections will provide information in BOLD print. This is to tell you about paperwork needed as proof of the information you put on your application, such as bank statements, birth certificates, paystubs, etc.

  • If you do not have the needed paperwork for each section your application cannot be fully processed until FSD receives everything.
  • If you do not provide all of the necessary paperwork, FSD will send you a “Request for Information” form detailing what paperwork you can provide and when it is needed. You may also receive an “Authorization for Release of Information” form(s). Then, you can either:
    • Send the requested paperwork and “Request for Information” form to FSD, or
    • Sign and send the “Authorization for Release of Information” form giving FSD permission to get the requested paperwork for you. It is your responsibility to make sure the paperwork is received by FSD.

ADDITIONAL SECTIONS - You may need to complete these added sections: 

  • If you have custody and control of one or more children and the other parent(s) are non-custodial, meaning they do not live with you and are not deceased, you MUST complete the following for each non-custodial parent of each child you include on your TA application:
    • Section 37 “Child Support Agreement,” and
    • Section 38 “Referral/Information for Child Support Services”
    • You may request more copies of the forms above if you need to list more than one non-custodial parent
  • If you choose to have your TA cash benefits directly deposited into your checking or savings account, complete:
    • Section 36 “Agreement for Direct Deposit” and provide a voided check, or have your bank complete Part III of the form

PROCESSING TIME - Your application will be processed within 30 days of your application date, unless you are missing information. Your application date is the date FSD receives your application within regular business/processing hours. If your application is received by FSD after regular business hours such as holidays, weekends or outside of regular operating hours, your application date is the next business day.

CHANGES TO OTHER BENEFITS - Information reported on your TA application will update any active case you have for Child Care Subsidy, Supplemental Nutrition Assistance Program (SNAP) also known as Food Stamps and/or MO HealthNet (Medicaid) programs. Therefore, if you have changes in income, resources, household members, etc., this can cause the benefit amounts for these other programs to change.

BENEFIT PAYMENTS - If approved for TA cash benefits, your first payment will be:

  • A partial month of benefits if FSD approves the application in the same month you apply, or
  • A full month of benefits if FSD approves the application the month after you apply.

HEARING RIGHTS - If you disagree with FSD's decision, you may ask for a hearing. For information on hearings, see “Important Information about Your Hearing Rights” in Section 34.

LIFETIME LIMIT - TA Cash Benefits has a 45-month lifetime limit

  • For teen parents under age 18 and in secondary (high) school, the months do not count toward the lifetime limit until you reach age 18.
  • TA benefits may be paid for longer than the lifetime limit if a participant is: 
    • Receiving treatment or services for domestic violence or substance abuse
    • Diagnosed and receiving treatment for mental health needs
    • Cooperating with the Children's Division open treatment plan and MWA job training program
    • In a temporary family crisis, such as a home fire, crime victim, company layoff, or serious injury.

To find your local Family Support Division (FSD) Resource Center or MWA office: 

  1. Go to: https://dss.mo.gov/offices.htm
  2. Enter your zip code and click Submit 
  3. Then scroll down and view the map with options to check for: 
    • FSD Resource Centers 
    • Missouri Work Assistance Centers (MWA) 
    • Food Pantries 
    • Community Action Agencies (CAA) Centers

FSD Information Center 

855-FSD-INFO (855-373-4636) 

Speak with a team member about FSD services, what benefits may be available to you and/or assistance with your application. 

To complete an interview 855-823-4908 

HOURS: Monday - Friday, 6:00 a.m. to 6:30 p.m.

 

FSD Automated Information Line 

800-392-1261 

Check the status of your assistance application. You will need your Social Security Number and date of birth when calling. 

HOURS: Answered 24 hours a day 7 days a week

Other Helpful Numbers:

Child Support: https://dss.mo.gov/child-support/

Rehabilitation Services for the Blind: 800-592-6004

Relay Missouri: 711 (Information line if you are hearing and/or speech impaired)

Text Telephone: 800-735-2966

TTD Voice Access: 800-735-2466

Applicant full legal name – FIRST, MIDDLE, LAST (current and maiden last name)

Physical Address - Enter house or apartment number, street or county road, city, state and zip code

Homeless Applicants only - General delivery address – enter post office name, city, state and zip code

Mailing Address - Enter PO box, house or apartment number, street or county road, city, state and zip code

*Texting/Email is not available in all locations.

Household members living with you must include YOURSELF AND PEOPLE WHO LIVE IN YOUR HOME. Include all household members who are related to you or your child(ren) either by blood or marriage.  As the applicant, you must be either the parent, legal guardian, conservator, or related to the child(ren) in need of assistance in the home. You must also apply for benefits for any other household members who are in your care, custody, and control.

Do Include: Spouse, Parent of child(ren) for which you are applying, Father, Mother, Sister, Brother, Grandfather, Grandmother, Uncle, Aunt, Nephew, Niece, First Cousin, Stepfather, Stepmother Stepbrother, Stepsister, Legal Guardian

Do NOT include: Children age 18 who are not in secondary (high) school, children age 19 and over, or unrelated friends that are not a legal guardian.

Joint Custody: If you have joint legal or physical custody of any child(ren) listed in your household, you must list the other parent as a household member on the “Members of your Household Section” Section 3 and mark them as “J” under “Applying for this member or Joint custody member.”

Social Security Number (SSN): Since you are applying for TA, you must provide a SSN for you and every household member who is included in the household.

  • Federal law requires you give a Social Security number (SSN) for anyone who wants to get Temporary Assistance. (42 U.S.C. § 1320b-7; 42 U.S.C. § 405(c)(2)(C), 7 U.S.C. §§ 2011-2036, and Social Security Act (SSA) of 1935 (Section 1137) as amended by P.L. 98-369).
  • Any member of your household (including you) that does not have a SSN and are legally able to get a SSN, must agree to apply for a SSN or that household member will not qualify for TA.
    • We will refer you to a Social Security office to apply for a SSN or
    • You can apply for a SSN online at ssa.gov. You can fill out and print an application for a Social Security Card.
  • Immigrants who are not legally able to get a Social Security number are not required to give one or apply for one.
  • If you are not applying for benefits for yourself, you do not have to give us your Social Security number. However, it may reduce the total amount of Cash Assistance benefits for the person you are applying for because we will not include you in the benefit amount.
  • We will not use your SSN as your Department Client Number (DCN) identification number.
  • We will not give any SSN to the United States Citizenship and Immigration Services (USCIS).
  • We use your information, including SSN, to:
    • Verify identity
    • Verify citizenship and immigration status
    • Verify income and resources
    • Prevent duplicate benefits
    • Establish and enforce child support
    • Computer match with state, local and federal agencies and our other programs to verify information
    • Collect money if we overpay you any benefits
    • Share with other government agencies and their contractors to assess Cash Assistance   

We may give your information to law enforcement officials for the purpose of arresting persons fleeing to avoid the law.

IMPORTANT information on citizen and immigration status:

  • To get the most help, you need to give us information about citizenship and immigration status for each person who is applying for help.
  • Giving us the citizenship and immigration status for all people who are eligible for benefits allows us to include them in the Temporary Assistance benefit amount. If you do not give us this information, the total TA benefit amount for your household may be lower. However, it will not affect the eligibility of the people you are applying for who have given us verification of their citizenship or qualified non-citizen status.
  • You do not need to give us information about citizenship and immigration status for any person who is not applying.
  • You do not need to give us information on income, resources, or other information for those who have not given us citizenship or immigration status information to complete the application process.
  • If you are not applying for any benefits yourself or if you choose not to provide citizenship or Immigration information, we will not try to find out this information from USCIS.
  • Citizenship information will be completed in Section 20.

How to complete Members of your Household Chart below:

  • Member name - Name of person living in your place of residence - List yourself first and then each member of the household. If you have joint 50/50 custody of any children in your household, you need to list the person you have joint custody with as a member of your household even though they are not living with you. This person will be marked as a Joint custody member.
  • Race - Enter: 1 for White, 2 for Black/African American, 4 for American Indian/Alaska Native, 4A for Federally recognized Tribe, 5 for Asian, 6 for Native Hawaiian/Pacific Islander, or 7 for Other 
  • Sex: M for Male, F for Female
  • Legal Relationship to You - by marriage, blood, or court, (example: spouse, son, daughter, legal guardian)
  • Marital Status - Enter: SGL for Single, M for Married, D for Divorced, W for Widowed, SEP for Separated 
  • Date married, divorced, separated, or widowed - enter the date of your marital status change
  • Date of Birth for this member
  • Applying for this member or joint custody member:  Y for Yes, N for No, J for Joint Custody (if this is the other parent that shares joint custody with you but does not live with you)
  • SSN (Social Security Number) - Provide member's Social Security number if they have one
  • Will Apply for SSN - Enter Y for Yes, N for No (only complete if the household member does not have a SSN)

Select your race, the options are White, Black or African American,  American Indian or Native Alaskan, Federally Recognized Tribe,  Asain,  Native Hawaiian or Pacific Islander, and Two or more races. 

Select your race, the options are White, Black or African American,  American Indian or Native Alaskan, Federally Recognized Tribe,  Asain,  Native Hawaiian or Pacific Islander, and Two or more races. 

If yes, complete this section:

By appointing an authorized representative, you are consenting to allow FSD to send letters and notices to your authorized representative. The person you appoint must be age 18 or older and know your situation well enough that they can complete your application or act on your behalf. They will not knowingly make a false or misleading statement, hide information, or fail to report any fact or event that is required to be reported by any law, regulation or rule of this State or the United States.

I/we authorize this person (over the age of 18) to be responsible for (check one or more boxes):

Authorized Representative's Full Legal Name (First, Middle, Last)

Authorized Representative's Mailing Address - Enter House or Apartment Number, Street or County Road, City, State and Zip Code

I/we understand that I/we am responsible for the information given by my/our authorized representative, including any information that may be incorrect.

  • You must use your TA cash benefit to help your child or children.
  • Your TA cash benefit payment may be sent to you on an electronic benefit transfer (EBT) card or by direct deposit into a bank account. If you are approved for TA and your direct deposit isn't set up for the first payment, the first check will be mailed to you.
  • You may not use your EBT card in:
    • Liquor stores
    • Casinos, or gaming establishments
    • Retail establishments that provide adult-oriented entertainment, and 
    • Any places or for any items that are used by adults 18 or older and are not in the best interest of the child or household.

TA Benefit Misuse is Illegal:

  • Your EBT transactions will be monitored. 
  • If you misuse your TA money, you may be investigated and have to repay the money.
  • You are breaking the law if you buy someone else's EBT card or payments, or sell your EBT card or payments.

TA Benefit Payment Method:

  • Below, tell us how you want to get your TA cash benefit payment if you are approved for TA. If you are choosing Direct Deposit, complete the Direct Deposit Application Form in Section 36 (page 26) of this application.

Answer The Following:

Direct Deposit Information (complete section 36 on page 26):

It will take at least 10 days to verify your bank account.

  • Any payment made before the bank verifies your account will be by check mailed to you or by electronic benefit transfer.
  • The payment is transferred to your bank on the date that checks are mailed for your type of assistance. If you have a question about whether a payment has been credited to your account, you can get this information from your bank.
  • If you need to change your direct deposit bank account, you can contact the Family Support Division Customer Service at 855-373-4636. Immediately request that the direct deposit to the current bank account be stopped. If you do not do this, your payment will be delayed.
  • Any payment made after your direct deposit account is closed will be in the form of a check mailed to you at your mailing address.

IMPORTANT  - Complete this section and cooperate with drug screening or treatment if you want to get and keep TA benefits

This section includes important information on drug screening and treatment. Non-cooperation with this section can cause you to be ineligible for TA for a period of 3 years!

  • Missouri law requires FSD to ask TA applicants questions about illegal drug use.
  • If you refuse to answer these questions, you are INELIGIBLE FOR TA FOR 3 YEARS. You may ask for a hearing if you disagree.*
  • You may be required to take a drug test 
    • You will receive a letter from the drug testing company telling you where and when to take your drug test.
    • If you do not show up for the appointment, do not have all the required paperwork as requested at the time of your drug test or do not complete the drug test, you will be INELIGIBLE FOR TA FOR 3 YEARS. You may ask for a hearing if you disagree.* 
  • You can go directly to substance abuse treatment instead of taking a drug test.
    • If you are using illegal drugs, you can agree to go to treatment right away if you answer “Yes” to question #2 in the “Drug Screening” section below.
    • If you are approved for TA, your benefits will not be reduced because of drug screening requirements if you are complying with the substance abuse treatment requirements under the Department of Mental Health (DMH).
  • If you test positive:
    • You must agree to join, participate, and successfully complete a substance abuse treatment program through the DMH or you will be INELIGIBLE FOR TA FOR 3 YEARS. You may ask for a hearing if you disagree.*
    • If you are approved for TA, your benefits will not be reduced because of drug screening requirements if you are complying with the substance abuse treatment requirements under the DMH.
  • If you are referred to a drug treatment program:
    • The DMH will contact you to assess your need for treatment.
    • If you do not show up for treatment or do not complete the treatment, you are INELIGIBLE FOR TA FOR 3 YEARS. You may ask for a hearing if you disagree.* 
    • If you are approved for Temporary Assistance, your benefits will not be reduced because of drug screening requirements if you are complying with the substance abuse treatment requirements under the DMH.
  • If you are ineligible for TA, you must tell FSD who your Protective Payee is
    • You must choose a person to receive the TA benefit for the rest of your household. This person is called a “protective payee”. If you do not choose a protective payee, FSD will choose this person. You may ask for a hearing if you disagree.*

*See Section 34 for “Important Information about your Hearing Rights”.

Drug Screening  - Answer the Following:

Ongoing Drug Test Referrals

  • If you are approved for TA and are age 18 or older and head of the household, your name will be matched with records from the Missouri Highway Patrol (MHP).
    • The FSD will send your name to the MHP so the MHP can match your name with their records.
    • MHP will send FSD information on drug-related arrests or convictions within the last 12 months.
    • If you had a drug related arrest or conviction, your name will be sent to a drug testing company.
    • The drug testing company will send you a letter telling you where and when to take your drug test.
    • If you do not show up for the appointment or do not complete the drug test, you are INELIGIBLE FOR TA FOR 3 YEARS. You may ask for a hearing if you disagree. See Section 34 for “Important Information about your Hearing Rights”.

The FSD needs to know information on the language you speak to better help you. The language you speak will not impact your ability to receive TA benefits.

If no, what language do you speak?

If Yes, list below. If this applies to you, start with yourself first.

If Yes, list below. If this applies to you, start with yourself first.

If Yes, list below. If this applies to you, start with yourself first.

If Yes, complete for each household member. If this applies to you, start with yourself first.

Resources (such as checking account) must be proven to process your application. If you have this information, provide it with this application. If you don't have this information, you will be asked to provide it at a later date. The FSD can help you get this information, but it is your responsibility to make sure the information is received by FSD.

If Yes, complete for each household member. If this applies to you, start with yourself first.

Burial plans must be proven to process your application. If you have a copy of the burial plan with the policy owner, insurance company name (if any), insurance policy number (if any), plan face value and plan benefit surrender value, provide it with the application. If you don't have this information, you will be asked to provide it at a later date. The FSD can help you get this information, but it is your responsibility to make sure the information is received by FSD.

If Yes, complete for each household member. If this applies to you, start with yourself first. If a household member has more than one job, list each job on separate lines.

We must have proof of employment to process your application. If you have a copy of paycheck stubs within the last 30 days, provide them with the application. If you don't have this information, you will be asked to provide it at a later date. The FSD can help you get this information, but it is your responsibility to make sure the information is received by FSD.

If Yes, complete below. If No, skip to section 13. 

We must have proof of self-employment to process your application. If you were self-employed for the entire year from Jan - Dec you can provide your most recent tax return. If you have not been self-employed for the entire year you can provide business ledgers, receipts, business account records, references etc. and provide them with the application. If you don't have this information, you will be asked to provide it at a later date. The FSD can help you get this information, but it is your responsibility to make sure the information is received by FSD.

  • The below ledgers must reflect income for the self-employment for the last 3 months.
  • The income recorded should be the same as what is required to be reported for the household member on your tax forms sent to the Internal Revenue Service (IRS).
  • You must indicate the month, year, gross income, total expenses and type of expenses. (you will be required to provide proof of this information).

List of other Income:

Child Support

Social Security  - Enter claim number:

Supplemental Security Income (SSI), 

Social Security Disability Income (SSDI), 

Old Age, Survivor and Disability Insurance (OASDI) 

Employer Sponsored Disability Payments

Trust Fund/Annuities                            

Interest or Dividends                             

Pension/Retirement/Disability

Veteran's Benefits

Unemployment Compensation             

Money from friends or relatives

Other  - Describe what other income you may have

If Yes, complete for each household member. If this applies to you, start with yourself first.

  • Other income must be proven to process your application. If you have any of the papers listed below, provide them with your application. If you don't have this information, you will be asked to provide it at a later date. The FSD can help you get this information, but it is your responsibility to make sure the information is received by FSD.
    • Trust Funds/Annuities and Pensions/Retirements - Award letter or statement from the plan showing the monthly income amount.
    • Veteran's Administration (VA) benefits - VA letter with the current benefit amount.
    • Money from friends or relatives - A written statement from the person who gave the money.

If yes, complete below for each household member. If this applies to you, start with yourself first. 

In this section answer "yes" for anyone tried as an adult or who had a trial scheduled. If the answer is "Yes" list all household members this applies to. If the question does not apply to anyone in the household answer "No".