Indiana
Indiana official forms and application routes
No One Left Outside provides source-based information. The issuing agency or plan decides eligibility, acceptance and availability.
- IMPACT Client Attendance Report - Vocational Education Training / Job Skills Training (Spanish) 54586
- Form number
- 54586
DFR: Forms - Reviewed 2026-11-02
- What it is for
- IMPACT Client Attendance Report - Vocational Education Training / Job Skills Training (Spanish) 54586
DFR: Forms - Reviewed 2026-11-02
- Issuing agency
- Indiana Family and Social Services Administration (FSSA); this form appears in the DFR forms catalog.
DFR: Forms - Reviewed 2026-11-02
- Notice Regarding Rights and Responsibilities for Supplemental Nutrition Assistance Program (SNAP) and Cash Assistance 54105
- Form number
- 54105
DFR: Forms - Reviewed 2026-11-02
- What it is for
- Notice Regarding Rights and Responsibilities for Supplemental Nutrition Assistance Program (SNAP) and Cash Assistance 54105
DFR: Forms - Reviewed 2026-11-02
- Issuing agency
- Indiana Family and Social Services Administration (FSSA); this form appears in the DFR forms catalog.
DFR: Forms - Reviewed 2026-11-02
- Notice Regarding Rights and Responsibilities for Supplemental Nutrition Assistance Program (SNAP) and Cash Assistance (Spanish) 54106
- Form number
- 54106
DFR: Forms - Reviewed 2026-11-02
- What it is for
- Notice Regarding Rights and Responsibilities for Supplemental Nutrition Assistance Program (SNAP) and Cash Assistance (Spanish) 54106
DFR: Forms - Reviewed 2026-11-02
- Issuing agency
- Indiana Family and Social Services Administration (FSSA); this form appears in the DFR forms catalog.
DFR: Forms - Reviewed 2026-11-02
- Authorized representative for SNAP (food assistance and cash assistance)
- Form number
- 53460
Authorized representative for SNAP (food assistance and cash assistance) - Reviewed 2026-11-02
- What it is for
- Authorized representative for SNAP (food assistance and cash assistance)
DFR: Forms - Reviewed 2026-11-02
- Issuing agency
- Indiana Family and Social Services Administration (FSSA); this form appears in the DFR forms catalog.
DFR: Forms - Reviewed 2026-11-02
- Authorized representative for health coverage form
- Form number
- 55366
Authorized representative for health coverage form - Reviewed 2026-11-02
- What it is for
- Authorized representative for health coverage form
DFR: Forms - Reviewed 2026-11-02
- Issuing agency
- Indiana Family and Social Services Administration (FSSA); this form appears in the DFR forms catalog.
DFR: Forms - Reviewed 2026-11-02
- Notice Regarding Rights & Responsibilities for Health Coverage 55367
- Form number
- 55367
DFR: Forms - Reviewed 2026-11-02
- What it is for
- Notice Regarding Rights & Responsibilities for Health Coverage 55367
DFR: Forms - Reviewed 2026-11-02
- Issuing agency
- Indiana Family and Social Services Administration (FSSA); this form appears in the DFR forms catalog.
DFR: Forms - Reviewed 2026-11-02
- Authorized Representative for Health Coverage (Spanish) 55371
- Form number
- 55371
DFR: Forms - Reviewed 2026-11-02
- What it is for
- Authorized Representative for Health Coverage (Spanish) 55371
DFR: Forms - Reviewed 2026-11-02
- Issuing agency
- Indiana Family and Social Services Administration (FSSA); this form appears in the DFR forms catalog.
DFR: Forms - Reviewed 2026-11-02
- Notice Regarding Rights and Responsibilities for Health Coverage (Spanish) 55372
- Form number
- 55372
DFR: Forms - Reviewed 2026-11-02
- What it is for
- Notice Regarding Rights and Responsibilities for Health Coverage (Spanish) 55372
DFR: Forms - Reviewed 2026-11-02
- Issuing agency
- Indiana Family and Social Services Administration (FSSA); this form appears in the DFR forms catalog.
DFR: Forms - Reviewed 2026-11-02
- Indiana Application for SNAP and Cash Assistance (state form 53263)
- Form number
- 53263
DFR: Forms - Reviewed 2026-11-02
- What it is for
- Indiana Application for SNAP and Cash Assistance (state form 53263)
DFR: Forms - Reviewed 2026-11-02
- Issuing agency
- Indiana Family and Social Services Administration (FSSA); this form appears in the DFR forms catalog.
DFR: Forms - Reviewed 2026-11-02
- Indiana Application for SNAP and Cash Assistance (Spanish) (state form 53622)
- Form number
- 53622
DFR: Forms - Reviewed 2026-11-02
- What it is for
- Indiana Application for SNAP and Cash Assistance (Spanish) (state form 53622)
DFR: Forms - Reviewed 2026-11-02
- Issuing agency
- Indiana Family and Social Services Administration (FSSA); this form appears in the DFR forms catalog.
DFR: Forms - Reviewed 2026-11-02
- Indiana Application for SNAP and Cash Assistance / Notice Regarding Rights and Responsibilities - Burmese English version 9900360
- Form number
- 9900360
DFR: Forms - Reviewed 2026-11-02
- What it is for
- Indiana Application for SNAP and Cash Assistance / Notice Regarding Rights and Responsibilities - Burmese English version 9900360
DFR: Forms - Reviewed 2026-11-02
- Issuing agency
- Indiana Family and Social Services Administration (FSSA); this form appears in the DFR forms catalog.
DFR: Forms - Reviewed 2026-11-02
- Claim to Defray Funeral and Cemetery Expenses SF 35937
- Form number
- 35937
DFR: Forms - Reviewed 2026-11-02
- What it is for
- Claim to Defray Funeral and Cemetery Expenses SF 35937
DFR: Forms - Reviewed 2026-11-02
- Issuing agency
- Indiana Family and Social Services Administration (FSSA); this form appears in the DFR forms catalog.
DFR: Forms - Reviewed 2026-11-02
- Indiana's Individualized Family Service Plan to Enhance the Capacity of Families to Meet the Special Needs of Their Children 46514
- Form number
- 46514
DFR: Forms - Reviewed 2026-11-02
- What it is for
- Indiana's Individualized Family Service Plan to Enhance the Capacity of Families to Meet the Special Needs of Their Children 46514
DFR: Forms - Reviewed 2026-11-02
- Issuing agency
- Indiana Family and Social Services Administration (FSSA); this form appears in the DFR forms catalog.
DFR: Forms - Reviewed 2026-11-02
- IMPACT Client Attendance Report - Vocational Education Training / Job Skills Training 47826
- Form number
- 47826
DFR: Forms - Reviewed 2026-11-02
- What it is for
- IMPACT Client Attendance Report - Vocational Education Training / Job Skills Training 47826
DFR: Forms - Reviewed 2026-11-02
- Issuing agency
- Indiana Family and Social Services Administration (FSSA); this form appears in the DFR forms catalog.
DFR: Forms - Reviewed 2026-11-02
- Applicant Job Search Rights and Responsibilities 48191
- Form number
- 48191
DFR: Forms - Reviewed 2026-11-02
- What it is for
- Applicant Job Search Rights and Responsibilities 48191
DFR: Forms - Reviewed 2026-11-02
- Issuing agency
- Indiana Family and Social Services Administration (FSSA); this form appears in the DFR forms catalog.
DFR: Forms - Reviewed 2026-11-02
- IMPACT Responsibilities, Sanctions, and Rights Voluntary Clients 49049
- Form number
- 49049
DFR: Forms - Reviewed 2026-11-02
- What it is for
- IMPACT Responsibilities, Sanctions, and Rights Voluntary Clients 49049
DFR: Forms - Reviewed 2026-11-02
- Issuing agency
- Indiana Family and Social Services Administration (FSSA); this form appears in the DFR forms catalog.
DFR: Forms - Reviewed 2026-11-02
- Application for Medicare Savings Program (QMB, SLMG, QI) 49228
- Form number
- 49228
DFR: Forms - Reviewed 2026-11-02
- What it is for
- Application for Medicare Savings Program (QMB, SLMG, QI) 49228
DFR: Forms - Reviewed 2026-11-02
- Issuing agency
- Indiana Family and Social Services Administration (FSSA); this form appears in the DFR forms catalog.
DFR: Forms - Reviewed 2026-11-02
- Application For Medicare Savings Program SF 49921
- Form number
- 49921
DFR: Forms - Reviewed 2026-11-02
- What it is for
- Application For Medicare Savings Program SF 49921
DFR: Forms - Reviewed 2026-11-02
- Issuing agency
- Indiana Family and Social Services Administration (FSSA); this form appears in the DFR forms catalog.
DFR: Forms - Reviewed 2026-11-02
- Revocation of Authorization 51736
- Form number
- 51736
DFR: Forms - Reviewed 2026-11-02
- What it is for
- Revocation of Authorization 51736
DFR: Forms - Reviewed 2026-11-02
- Issuing agency
- Indiana Family and Social Services Administration (FSSA); this form appears in the DFR forms catalog.
DFR: Forms - Reviewed 2026-11-02
- Protective Payee for Hoosier Works Card 49884
- Form number
- 49884
DFR: Forms - Reviewed 2026-11-02
- What it is for
- Protective Payee for Hoosier Works Card 49884
DFR: Forms - Reviewed 2026-11-02
- Issuing agency
- Indiana Family and Social Services Administration (FSSA); this form appears in the DFR forms catalog.
DFR: Forms - Reviewed 2026-11-02
- IMPACT Responsibilities, Sanctions, and Rights Voluntary Clients (Spanish) 54465
- Form number
- 54465
DFR: Forms - Reviewed 2026-11-02
- What it is for
- IMPACT Responsibilities, Sanctions, and Rights Voluntary Clients (Spanish) 54465
DFR: Forms - Reviewed 2026-11-02
- Issuing agency
- Indiana Family and Social Services Administration (FSSA); this form appears in the DFR forms catalog.
DFR: Forms - Reviewed 2026-11-02
- FSSA Legislative Inquiry: Authorization to Act on Constituent's Behalf (state form 54530)
- Form number
- 54530
DFR: Forms - Reviewed 2026-11-02
- What it is for
- FSSA Legislative Inquiry: Authorization to Act on Constituent's Behalf (state form 54530)
DFR: Forms - Reviewed 2026-11-02
- Issuing agency
- Indiana Family and Social Services Administration (FSSA); this form appears in the DFR forms catalog.
DFR: Forms - Reviewed 2026-11-02
- Authorization for disclosure of personal and health information
- Form number
- 54621
Authorization for disclosure of personal and health information - Reviewed 2026-11-02
- What it is for
- Authorization for disclosure of personal and health information
DFR: Forms - Reviewed 2026-11-02
- Issuing agency
- Indiana Family and Social Services Administration (FSSA); this form appears in the DFR forms catalog.
DFR: Forms - Reviewed 2026-11-02
- Authorized Representative for SNAP (food assistance) and Cash Assistance (Spanish) 53461
- Form number
- 53461
DFR: Forms - Reviewed 2026-11-02
- What it is for
- Authorized Representative for SNAP (food assistance) and Cash Assistance (Spanish) 53461
DFR: Forms - Reviewed 2026-11-02
- Issuing agency
- Indiana Family and Social Services Administration (FSSA); this form appears in the DFR forms catalog.
DFR: Forms - Reviewed 2026-11-02
- Application for Search of Certified or Non-Certified Copy of a Death Record
- Form number
- 49606
Vital Records: Order Certificates - Reviewed 2026-11-02
- What it is for
- Application for Search of Certified or Non-Certified Copy of a Death Record
Vital Records: Order Certificates - Reviewed 2026-11-02
- Issuing agency
- Indiana Department of Health, Division of Vital Records
Vital Records: Contact Us - Reviewed 2026-11-02
- Application for Search and Certified Copy of Birth Record
- Form number
- 49607
Vital Records: Order Certificates - Reviewed 2026-11-02
- What it is for
- Application for Search and Certified Copy of Birth Record
Vital Records: Order Certificates - Reviewed 2026-11-02
- Issuing agency
- Indiana Department of Health, Division of Vital Records
Vital Records: Contact Us - Reviewed 2026-11-02