Use Form 2378B when:

  • the applicant is unable to come in for an interview, or
  • the AIS printer does not work and the screener or interview copy of Form 2378C signature page(s) does not print, or
  • an applicant for medical only does not want to come in for an interview.

If only the first page of Form 2378B is received with a name, address and signature, register a cash and SNAP application.

When a Form 2378B is used as a mail-in application, the applicant's signature on the rights and responsibilities pages of Form 2378B delete textis sufficient. No additional signatures are required.

For Family Health Plans, Form 2378B may be processed without contact with the family. delete textForm 267TPL is not required. If the application is not complete or the family does not submit all the necessary proofs with the application, send Form 267F (Instructions to the Client) requesting the needed information. See WAG 02-07-02 for further instructions.

A client contact is still required for persons applying for AABD Medical since there is no asset information on the Form 2378B

Both Parents in the Home

When only one parent can come to the FCRC for the eligibility interview, have them sign the rights and responsibilities pages of Form 2378C delete textat the eligibility interview. Enter the client's name and address on Form 2378B delete text. For TANF Cash, give the forms to the client for the other parent to sign and return.

AIS Printer Not Functioning

When the screener or interview copy of Form 2378C signature page(s) does not print, have the client sign on the rights and responsibilities page of Form 2378B. File Form 2378B in the Application section of the case record.