Privacy & Use of Information
We’ll keep your information private as required by law. Your answers on this application will only be used to determine eligibility for DoAS assistance programs. We’ll check your answers using the information in our electronic databases and the databases of other states or federal agencies. If the information doesn’t match, we may ask you to send us proof.
Important: As part of the application process, we may need to retrieve your information from the Internal Revenue Service (IRS), Social Security, the Department of Homeland Security (DHS), and/or a consumer reporting agency. We need this information to check your eligibility for coverage and to give you the best service possible. We may also check your information at a later time to make sure your information is up to date. We’ll notify you if we find something has changed.
Learn more about the DHS Notice of Privacy Practices in
English or Spanish.
I agree to have my information used and retrieved from data sources for this application. I have consent for all people I’ll list on the application for their information to be disclosed as well as retrieved and used from data sources.
I understand that I’m required to provide true answers and that I may be asked to provide additional information, including proof of my eligibility. If I don’t provide true answers, I may face penalties including losing my eligibility for coverage.