Step 1 – Gather Necessary Information

The following information will be needed to complete your Pre-Application:
• Pay stub(s) received within the past 45 days or the previous year’s Federal Income Tax Form 1040 for everyone receiving income in your household.
• If anyone is self-employed, please have the most recent 3-month profit and loss statement or the previous year’s Federal Income Tax Form 1040 and Schedule C.
• Birth dates for every child in your household you wish to enroll in Healthy Families.
• Amounts you pay for child daycare expenses (if applicable).
• Amounts you pay for disabled dependent care (if applicable).
• Amounts for any child support or alimony either paid or received (if applicable).
You may have questions with regard to the necessary documents for your specific situation. You will find more information in the Frequently Asked Questions, Financial section.

Step 2 - Contact Us

There are four ways to contact a Certified Application Assistant and start your enrollment:
1. The easiest way is to click on the telephone icon on the left, enter your telephone number in the form that pops up on your screen and we will call you back within the next business day. Have the necessary information (see Step 1 above) with you and the Assistant will complete the Pre-Application for you on the telephone.
2. If you would rather complete the Assessment Application on your own, before speaking with an Application Assistant, click on the laptop icon. Complete the Application online and click the “Submit” button at the bottom of the form. A Certified Application Assistant will call you back within the next business day at the time you indicate on the form.
3. Book an appointment by clicking on the calendar icon. Give us your name and the day and time you would like us to give you a call. Assistants are available Monday through Friday, from 8:00 am to 7:00 pm. Remember to have the required information ready at the time you request an appointment.
4. You may also call us direct and toll-free at 1-866-682-9903. Assistants are available to take your call Monday through Friday, from 8:00 am to 6:00 pm.
The telephone call usually takes about 20 minutes if you have all of the necessary information handy.
Be sure you have a pen and paper with you to write down any information your Application Assistant gives you.

Step 3 – Follow Up

Following the telephone call, you will be sent your Rights and Declaration via fax or through the mail. Once you’ve reviewed the document…
• Sign and date where indicated
• Fax or mail the application to the fax number / address provided on the form.
• Include the documentation noted in the cover letter:
- Proof of income
- Expenses
- Child(ren)’s legal residency address
Required information can vary; you may be required to provide additional documents based on your income sources. You will find more information in the Frequently Asked Questions, Financial Documents section.
Within 14 business days after your completed application is submitted you should receive a letter with all necessary information about your children’s acceptance into the Healthy Families Program. We will update you with the status of your application through email however you can always contact us at 1-866-682-9903 or send an email to This e-mail address is being protected from spambots. You need JavaScript enabled to view it