Below you will find frequently used forms that can help you to apply for certain social services that may benefit you and/or your family. There is a description of the service and a link to access the downloadable form(s). Please note that the Suffolk Care Collaborative does not process these forms nor determine eligibility. Please follow the instructions on each form and use the contact information provided on the application if you have questions.
Single Point of Access (S.P.A.)
The Single Point of Access application is used for individuals who wish to apply for residential services in Suffolk County and who have Mental Health conditions. Applicants must complete the application, sign the application, and gather information that includes a psychiatric evaluation, a psychosocial summary, a physical exam with a PPD and an authorization form signed by a physician.
Suffolk County Accessible Transit (SCAT)
The SCAT application is used to access paratransit services in Suffolk County. The paratransit services are used for persons with disabilities that affect them from using the public bus system. Applicants must submit an original application (no photocopies) along with two passport size photographs.
Logisticare is an organization that authorizes and organizes transportation for medically necessary rides for Medicaid recipients. In order to be eligible for Logisiticare, applications must request a form be completed by their medical providers indicating the medical necessity of their appointments.
Medicaid is a government sponsored insurance program that provides health coverage to individuals with low income. Medicaid applications can be submitted in paper format for those individuals that are disabled or over 65 years of age, or it can be completed online for individuals outside of those categories.
Supplemental Security Income (SSI)
SSI is a federal income support program that provides additional income to individuals that are aged, blind, or disabled and have little to no income. In order to apply, individuals must conduct a telephone interview with the Social Security Administration by calling 1-800-772-1213.
Social Security Disability (SSD)
SSD is an income for individuals that have are disabled and have worked enough credits to become “insured”. SSD can also be provided to disabled widows or widowers if their spouse has worked enough credits and is also available to disabled individuals under age 22 if their parents are deceased or disabled and have worked enough credits. The SSD application must be submitted online.
Supplemental Nutrition Assistance Program (SNAP)
SNAP is also known as food stamps, and is a program that provides money to be used in the purchase of food. Eligibility is based on income and family size. You do not have to be eligible for Medicaid to receive SNAP benefits.
Temporary Assistance for Needy Families (TANF)
TANF is a program that provides temporary financial assistance to pregnant women and families with one or more dependent children. These funds can be used to help pay for food, shelter, utilities and or expenses but cannot be used for medical expenses.
Health Care Proxy
A Health Care Proxy is a form that individuals complete that allows you to appoint someone you trust to make health care decisions for you if you should lose the ability to do so for yourself. Health Care Proxies must be witnessed by two people (not including yourself or your proxy) and the form can be changed and updated at any time. A Health Care Proxy should be carried with you and copies should be provided to your health care team.
A Living Will is a form that allows individuals to specify certain types of care they do or do not want if they are no longer able to speak for themselves. This form only becomes effective if you have a terminal illness or are at the end-of-life and unable to make these decisions yourself. This form must be witnesses by two people (not including yourself) and should be provided to your health care team.