Customer Help - Caretaker Supplement (CTS)


ApplicationF-22571 (PDF, 288KB) — To apply for Caretaker Supplement  benefits.

Caretaker Supplement (CTS) Instructions for Application (English, Spanish) (PDF)

Fair Hearing Request (exit DHS) - To request a hearing if you don't agree with a decision about your benefits.

Fair Hearing Voluntary Withdrawal — DHA 17, (PDF 10KB) *(exit DHS) — If you want to withdraw your request for a hearing.

Self-Employment Income Report (SEIRF) form — F-00107, (English, Hmong, Spanish) (PDF  KB) — Use this form to report self-employment income.


More information can be found at

Other Links

Agency Directory - To find the telephone number and address of your local agency.

Legal Services - To find the name and telephone number of who in your area can provide you with legal help.  You may also go to:


Last Revised: November 20, 2014