Benefits Access Survey

ASIDE FROM providing information and referral services, please indicate which of the following benefits your organization either helps consumers access (eg. application assistance) OR provides the service directly.

* Indicates required field

Organization: *

Name: *

First

Last

PLEASE INDICATE ALL THAT APPLY. IF YOU ARE NOT CERTAIN, DO NOT CHECK.

(provide additional information here) *

3. HOUSING *

Section 8 Other:

(provide additional information here) *

5. HOME SUPPORTS *

Home Care Assistance Home Chores Other:

(provide additional information here) *

6. HOME OWNERSHIP *

Property Tax Relief Veterans Home Assistance Weatherization Other:

(provide additional information here) *

7. UTILITY *

Home Heating Tax Credit Low Income Home Energy Assistance Program (LIHEAP) Other:

(provide additional information here) *

8. LEGAL/MEDICAL AFFAIRS - MANAGEMENT *

Guardian (PERS) Other:

(provide additional information here) *

10. EMPLOYMENT *

Senior Community Service Employment Program (SCSEP) Work Income/Employment Other:

(provide additional information here) *

11. NURSING HOME & LONG TERM CARE ISSUES *

Veterans HOME Program Nursing Home Medicaid - Spousal Impoverishment Mi Choice Waiver Program Other:

(provide additional information here) *

Submit