Create Account

*Required Fields

To continue, please create an account.You will be asked to enter information for the household.

User Information

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Verify Your Identity

If you are applying for benefits for you and/or your family, please enter your social security number if you have one. You are only required to provide the social security number if you are applying for benefits.

Why do we need this information for the person completing the application?

The person filling out the application is our main contact for your household.

You may be filling out the application because you are applying for health coverage or human service benefits for yourself, or you may be filling it out for members of your household. (Depending on the program that you are applying for, members of your household can be people who live with you, all the people on your tax return, or if you are applying for SNAP, people with whom you buy and prepare food. We will provide more information later about who to include, when we ask you to tell us about your household.)

If you are applying for certain health insurance programs, we may need to verify the identity of the person filling out the application. In order to do this, we need you to provide your name, birth date and if you have one, your Social Security number.

If you are applying for benefits for yourself and you have a Social Security number, you are required to provide it to receive health coverage or a tax credit to help pay for insurance.

If you are applying for benefits for your children or other dependents only, you are not required to supply your Social Security number. However, if you do not supply your Social Security number, your application may take longer to process for some programs and delay your family's enrollment.

Please be sure to enter your Social Security number and birth date correctly because it will be difficult to edit later if you make a mistake.

Security Questions
Username and Password

Must be 5-15 letters or numbers, starting with a letter.

Your Password must:

  • Be between 8 and 15 characters long;
  • Have at least one number;
  • Have at least one special character from the following list: !@#$_=
  • Have a mixture of at least one uppercase and at least one lowercase letter;
  • Do not repeat characters more than two times (example: 'Passsword' is not allowed);
  • The password cannot contain the username.

User Acceptance Agreement

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