[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-305508-105":3,"detail-sidebar-cat-1-en-105":81,"doc-detail-305508-en":126},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","st-johns-county-social-services-application-application-form-read-online-free","St. Johns County Social Services Application - Application Form - read online free","","St. Johns County Social Services Application collects detailed information from an applicant and all household members, including identities, contact details, household composition, marital status, safety status, veteran status, medical condition details, and referral sources. It requests assistance needs such as financial support amounts, medical assistance options, navigational services, and benefit information for programs like Medicaid, Medicare, Food Stamps, Social Security, and SSI/SSD. The form also gathers income, expenses, and asset ownership, ending with applicant certification and authorization to release information.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/forms/","Forms",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/st-johns-county-social-services-application-application-form-read-online-free/305508/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/st-johns-county-social-services-application-application-form-read-online-free/305508.png","ImageObject",442,249,{"name":42,"@type":43},"Kurz","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-14","2026-09-19",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",5,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What information is required for the applicant and all household members?","Question",{"text":63,"@type":64},"The form requires complete household member details including names, relationships, dates of birth, Social Security numbers, employer or school, date employed, and gross monthly income.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What kinds of assistance and programs does the application request?",{"text":68,"@type":64},"It collects the amount of financial assistance requested and choices for rent, deposit(s), utilities, utility deposits, application fees, medical assistance options, and navigational services such as help applying for Medicaid/Food stamps and community referrals. It also asks about Medicaid, Medicare, Food Stamps, Social Security, SSI, and SSD benefits and denials.",{"name":70,"@type":61,"acceptedAnswer":71},"Does the application include an assets and income/expense section?",{"text":72,"@type":64},"Yes. It includes an asset assessment sheet covering home and other property ownership, sold property in the last two years, current values, amounts owed, and bank or investment holdings. It also lists income totals and itemized monthly expenses.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},305508,1790220938,{"code":4,"msg":82,"data":83},"success",[84,89,94,99,104,109,113,118,122],{"id":85,"doc_module":22,"doc_module_name":25,"category_name":86,"show_sort_weight":87,"slug":88},11,"Presentations",90,"presentations",{"id":90,"doc_module":22,"doc_module_name":25,"category_name":91,"show_sort_weight":92,"slug":93},12,"Resumes",80,"resumes",{"id":95,"doc_module":22,"doc_module_name":25,"category_name":96,"show_sort_weight":97,"slug":98},14,"Invoices",70,"invoices",{"id":100,"doc_module":22,"doc_module_name":25,"category_name":101,"show_sort_weight":102,"slug":103},15,"Posters",60,"posters",{"id":105,"doc_module":22,"doc_module_name":25,"category_name":106,"show_sort_weight":107,"slug":108},16,"Social Media",50,"social-media",{"id":110,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":111,"slug":112},17,40,"forms",{"id":114,"doc_module":22,"doc_module_name":25,"category_name":115,"show_sort_weight":116,"slug":117},18,"Letters",30,"letters",{"id":119,"doc_module":22,"doc_module_name":25,"category_name":120,"show_sort_weight":55,"slug":121},21,"Paper Templates","papers-templates",{"id":123,"doc_module":22,"doc_module_name":25,"category_name":124,"show_sort_weight":4,"slug":125},158,"General","general-158",{"code":4,"msg":82,"data":127},{"doc_id":79,"user_id":128,"nickname":42,"user_avatar":129,"doc_module":22,"category_id":110,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":95,"language":135,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":12,"update_tm":139,"read_time":55},2336478945635,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","St. Johns County Social Services Application  \nDate: County:  \n\n| Client’s Name: |  | Sex: |  |\n| --- | --- | --- | --- |\n| Other names known by: |  |  |  |\n| Phone \\#: | Social Security \\#: |  | Birthdate: |\n| Address: |  |  |  |\n| Mailing Address: |  |  |  |\n| Email Address: |  |  |  |\n| Who are the members of your household? (adults/children/ages) |  |  |  |\n\n\n| Marital Status: Single | Married | Divorced Annulled | Separated Widowed | Refused |\n| --- | --- | --- | --- | --- |\n| Race: Native American Pacific Islander | Asian\u003Cbr>White | Black/African American Refused | Native Hawaiian or | Other |\n| Ethnicity: Hispanic/Latino Not Hispanic/Latino Refused |  |  |  |  |\n| Where did you stay last night? |  |  |  |  |\n| Do you feel safe in your situation? Yes No |  |  |  |  |\n| Is there a veteran in your household? Yes No |  |  |  |  |\n| Next of Kin: |  | Contact \\#: |  |  |\n| Date at Current Address: |  | Date moved to County: Date moved to Florida: |  |  |\n| Are you homeless? Y N |  | At risk of homelessness? Y N |  |  |\n\nPlease tell us what we can do to help you today:  \nAmount of Financial Assistance Requested:  \n  Rent   Deposit(s)   Utility   Utility Deposit  Application Fee  \nMedical Assistance:  \n  Voucher for specialty physician or medical testing   Inpatient Hospital Stay  \nNavigational Services:  \n  Assistance applying for Medicaid/Food stamps   Housing  \n  Food Assistance   Community Referrals  \n  Resource Center   Tokens  \n  Cremation   Birth Certificates/ID’s  \nHow were you referred to our offices?   Disabling Condition? Yes No Refused  \nDescription of condition:   Do you have a medical problem?   How long have you had this problem?  was it caused by an accident?  \nYes No  \nIf yes, explain   What is your doctor’s name:    \nHave you received a monetary settlement in the past five years? If so, what amount?$   \nInsurance ID \\# (i.e. , Medicare, Medicaid, AARP, BC/BS, AFLAC, etc. )   \nBENEFIT INFORMATION: Do you have or have you recently applied for any of the following?  \nMedicaid-Have you received a denial for Medicaid?    \nMedicare HMO Group Health Food Stamps  \nMedicaid Medically Needy/Share of Cost $   \nSocial Security Retirement Benefits Vocational Rehabilitation Services  \nAre you a Veteran? YES NO  \nV/A Benefits-Branch of Service:   Dates of Services:   \nSocial Security Disability (SSD) Benefits SSI Date ofApplication  Have you ever received a denial for SSD and/or SSI?    \nAre you a U.S. Citizen? YES NO  \nIf NO, you must provide a copy of your Permanent Resident Alien Card.  \nDate admitted to United States  Are you sponsored? If so, by whom   \nPlease provide the following information on all members of your household including yourself: Household Information **MUST BE COMPLETED IN FULL**  \nName Relationship DOB  \nSocial Security Number  \nEmployer/School  \nDate employed  \nGross Monthly Income  \n\n|  |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- |\n|  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |\n|  |  |  |  |  | Total Earned Income | $ |\n\nIf unemployed state  \nreason:   \nDate Last Employed:   Last Place of Employment:   \nExpenses: Income:  \n\n| Auto Insurance |  |\n| --- | --- |\n| Cable |  |\n| Car |  |\n| Childcare |  |\n| Child Support |  |\n| Credit Cards |  |\n| Electric |  |\n| Food |  |\n| Furniture |  |\n| Gas-Auto |  |\n\n\n| Gas-Heating |  |\n| --- | --- |\n| Health Insurance |  |\n| Home Insurance |  |\n| Life Insurance |  |\n| Medical Bills |  |\n| Medication |  |\n| Mortgage |  |\n| Phone |  |\n| Rent |  |\n| Water |  |\n| Total Expenses |  |\n\n\n| Unearned Income |  |\n| --- | --- |\n| Child Support |  |\n| Unemployment |  |\n| Workers Compensation |  |\n| Alimony |  |\n| Social Security (SSI/SSDI) |  |\n| Food Stamps |  |\n|  |  |\n| Other:  |  |\n| Earned Income Total |  |\n| Total Income |  |\n\nASSET ASSESMENT SHEET  \nDo you own/ or are you buying a home YES NO  \nAmount mortgaged $  Name of Mortgage Holder   D","cbCaigB6ZEHplKQK","https://ap.wps.com/l/cbCaigB6ZEHplKQK","pdf",1413019,"English","# Client Information\n## Household Members\n## Marital Status, Race, and Ethnicity\n## Safety, Veteran, and Next of Kin\n# Assistance Request\n## Financial Assistance Amounts\n## Medical Assistance and Navigational Services\n## Condition and Referral Details\n## Benefit Information\n# Citizenship and Immigration Details\n# Household Member Details (MUST BE COMPLETED)\n# Income and Expenses\n## Income Totals\n## Expense Categories\n# Asset Assessment Sheet\n## Home and Property Ownership\n## Accounts and Investments\n# Applicant Statement and Authorization","[{\"question\":\"What information is required for the applicant and all household members?\",\"answer\":\"The form requires complete household member details including names, relationships, dates of birth, Social Security numbers, employer or school, date employed, and gross monthly income.\"},{\"question\":\"What kinds of assistance and programs does the application request?\",\"answer\":\"It collects the amount of financial assistance requested and choices for rent, deposit(s), utilities, utility deposits, application fees, medical assistance options, and navigational services such as help applying for Medicaid/Food stamps and community referrals. It also asks about Medicaid, Medicare, Food Stamps, Social Security, SSI, and SSD benefits and denials.\"},{\"question\":\"Does the application include an assets and income/expense section?\",\"answer\":\"Yes. It includes an asset assessment sheet covering home and other property ownership, sold property in the last two years, current values, amounts owed, and bank or investment holdings. It also lists income totals and itemized monthly expenses.\"}]","St. Johns County Social Services Application - Application Form - read online free | PDF",1789825589]