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Food Stamp Forms

Forms you can print and file

by: Michigan Department of Human Services

DHS 1171 Form
This application can be used for Food Assistance Program (FAP) Family Independent Program (FIP), Medicaid, Child Day Care and State Emergency Relief (SER).  This application can be obtained by calling your local DHS office or on-line at:

Request for Hearing PDF
Use this form to request a hearing through DHS. You can also request a hearing by signing the back of your DHS notice, by writing a note to your caseworker, or by calling your caseworker and asking for a hearing orally. 

Appointment of Authorized Representative (sample form) PDF
Use this form to appoint an authorized representative. An authorized representative should know about your family’s situation and have information about your income and expenses. This person can be a friend, family member, agency staff person, or anyone else you trust. This person must be age 18 or older.

Consent to Release Information (sample form) [Also in PDF]
Use this form to give DHS permission to discuss your case with a particular person. Normally caseworkers must keep all information about your case confidential.

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