Application Information

How to Apply


You can file an application online at myBenefits. The completed online application will be sent to the agency and you will be scheduled for a phone interview to determine eligibility. Your application will also be screened for expedited Supplemental Nutrition Assistance within five days and if you are eligible the interview will be scheduled within five days.

Print the application

Download and print the application.  Once you complete the application you can submit it one of the following ways:

  • Scan and email it to temporaryassistance@chqgov.com 
  • Fax it to 716-661-8225
  • Mail or hand deliver it to one of the following Social Services Offices:

    110 East Fourth Street          319 Central Avenue
    Jamestown, NY 14701          Dunkirk, NY  14048

You can come into one of our two locations which are listed above. We will give you an application. You can submit it that day as long as you have fully completed and signed the application. It is also helpful if you can provide a phone number where we can reach you if we have questions. We will give you an appointment for a future interview which can be done by telephone or in-person.

You are responsible to complete your application completely and truthfully. At application, periodic report and recertification you must report all employment income and any unearned income such as disability benefits, child support, unemployment benefits and lottery winnings. If your household currently has no income and you receive a change in income you must report the changes within 10 days after the end of the month in which the change happened. The information and proof that you provide when applying for or while receiving temporary assistance must be correct, complete and accurate. 

What to Expect

When you apply you may be asked to complete a short questionnaire that helps us prepare for your eligibility interview.  You have the right to turn in an application the same day you get it and an interview will be scheduled.

Pre-Screening Interview

You may be pre-screened (have a short interview) to determine if you have any emergencies that need to be taken care of immediately. If you have one of the following:

  • You are homeless
  • You have little or no food
  • You have been told by your landlord you must move or you have been given eviction papers
  • During the heating season you are out of fuel or have less than a seven-day supply
  • Your utilities are shut off or you have received a shut off notice
  • You or someone in your family has been beaten, abused or threatened with violence by another member of your family

The pre-screener will help you with your emergency and then schedule an eligibility interview for ongoing benefits for you.

Eligibility Appointment

If you do not have one of the emergencies mentioned above an eligibility appointment will be scheduled for ongoing benefits for you.

Self-Sufficiency Plan

TA is a temporary service and if able, you will be expected to be involved in employment, work experience, training, or another activity to help you become self-sufficient. You may be scheduled to come to a meeting with a case manager to complete an employment assessment and an individual employment plan. This is to assess your strengths and abilities to determine what type of employment or training may best suit you. You may also be asked to take a reading and math test called TABE. This is done to determine if you need additional help with reading or math that will help you become successful with your individual employment plan.

You must keep your eligibility appointment to find out if you are eligible for ongoing assistance for you and your family.

Eligibility Interview

During your eligibility interview, an examiner will go over your application with you to make sure it is complete and that you understand each question. You will also be asked to document and/or verify your response to questions on your application. Some of the things you may be asked for are:

  • Birth certificates or other verification of identity for yourself and your family members
  • Verification of Social Security numbers for yourself and family members
  • Proof of residence and shelter expense such as a rent receipt or mortgage payments
  • Fuel or utility receipts
  • If employed, current wage verification
  • Proof of any other type of income such as but not limited to support, veterans benefits, unemployment insurance benefits, Social Security benefits, SSI, pensions, etc.
  • Proof of any resources such as but not limited to bank statement, insurance policies, ownership of real property, motor vehicles, etc.
  • If you state you are disabled, you may be asked to sign a consent to have your doctor complete a medical statement

Child Support Enforcement

If you have a child whose other parent is absent, you may be required to have an interview with the Child Support Enforcement Unit to seek support and/or establish paternity. You have the right to claim good cause for not cooperating with the Child Support Enforcement Unit in establishing paternity or seeking support, if you have been physically or mentally threatened, abused, or fear for the life of you or your child. You must be able to substantiate your claim.

Alcohol & Substance Abuse

If you have a problem with alcohol or substance abuse or are suspected of having a problem you may be asked to see a counselor who will assess your treatment needs. They can assist you with getting the care that you may need to become successful in attaining self-sufficiency.

Domestic Violence Screening

You will be given the opportunity to complete a voluntary Domestic Violence Screening form and be provided with important information on how to obtain Domestic Violence Services. Anyone who voluntarily self-discloses the presence of domestic violence will be afforded the opportunity to talk to a Domestic Violence Liaison.

Additional Eligibility

When applying for Temporary Assistance, you will also be applying for Medical Assistance and SNAP benefits. Your eligibility determination will also inform you of your eligibility for these other programs. You have the right to a determination within 30 days of the date you submit your application.