Application Assistors
The following information is made available as a resource for certified Community Application Assistance sites. NH Healthy Kids partners with hospitals and community health centers in New Hampshire to provide application assistance in the community. These Community Application Assistance sites are trained by NH Healthy Kids to help families complete their NH Healthy Kids application.
If you are applying for NH Healthy Kids and need help with your application, please call us at 1-877-464-2447 for a list of sites in your area.
Manuals
2010 Certified Application Assistance Manual
This manual provides helpful information and instructions for Community Application Assistors to help families complete a NH Healthy Kids application.
Helpful Forms
CAA Coversheet
Use this coversheet for all applications you submit.
Cash Pay Form
Use this form for individuals who receive cash pay from jobs like yard work, babysitting, etc. and that will not be filed on a tax return in the future.
Change of Address Form
Use this form as notification of a family's changes of address.
Employment Verification Form
This form can be filled out by an employer as a verification of wages earned.
Form 11
If you are assisting a family with an application, use this form to gain authorization to discuss case information with NH Healthy Kids and DHHS.
Identification Form for Children Under 16
This form can be completed by your child’s school or day care to prove identity.
*Note: Children 16 or older need to send a photo ID.
Income Guidelines
Current Income Guidelines chart
Self Employment Form
Use this form if an individual is self-employed and has not yet filed a tax return.
Trainings
Annual Beginner Training, hosted at the NH Healthy Kids office January 24, 2012 from 9:30-11:30. This training is for new Application Assistors in NH and is required before individuals can sign off and receive reimbursement for applications submitted on behalf of an agency. Get more information or register by or by calling Mollie at 603-228-2925 ext. 222.
Annual Application Assistor Training October 2010 - PowerPoint
Assisting Pregnant Women Training (PDF)
Customized Trainings
If you would like to request a training for your agency, please call Mollie at 1-877-464-2447 ext. 222.
CAA Newsletters & Updates
Outreach materials such as brochures
and bookmarks
are a great way to
share information
about our programs
with families.
If you would like to get involved in helping reduce the number of uninsured kids in your community, contact your field coordinator today.