Access Arkansas is a service of the Arkansas Department of Human Services. Contact Us
Please provide the requested information for each adult, 18 years or older, in your household.
Resident of Arkansas?
U.S. Citizen or Legal Alien?
Has a Social Security Number?
Age
Gross Monthly Income
Married?
Currently Receiving TEA Benefits?
Currently Receiving SSI Benefits?
Receiving Disability Benefits from SSI/VA/Medicaid?
Physical Limitations?
Requires help with activities of daily living or personal care?
Vision Problems?
Cerebral Palsy, Epilepsy, Autism, Retardation, or other developmental disability?
Meets Definition of a Refugee?
Currently Receiving/Eligible for Medicare Benefits?
Currently Pregnant?
Have you aged out of Foster Care in Arkansas?
Please provide the requested information for each child in your household.
Resident of Arkansas?
US Citizen or Legal Alien?
Has a Social Security Number?
Age
Gross Monthly Income
Currently Receiving TEA Benefits?
Currently Receiving SSI Benefits?
Receiving Disability Benefits from SSI/VA/Medicaid?
Meets any of these requirements for Arkansas Better Chance?
Vision Problems?
Cerebral Palsy, Epilepsy, Autism, Retardation, or other developmental disability?
Each parent living with child is either a full time student or works 30 hours or more per week?
Chronic Medical Condition?
Please provide the requested information for your household.
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