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Health & Human Services
Basic Assistance
Forms and Documents
Forms and Documents
Cash Contribution Form (pdf)
CLARITY - Client Consent Release (pdf)
Employment Verification Form (pdf)
HHS Program Guidelines (pdf)
Income-in-Kind Form (pdf)
Landlord Letter - Past Due (pdf)
Landlord Letter - Prospective (pdf)
Mortgage Letter - Past Due
New Employer Form (pdf)
Nye County Application - Additional Adults.pdf
Nye County Application - Additional Child (pdf)
Nye County Application - Additional Household Members (pdf)
Nye County Application - Authorization for Release of Info (pdf)
Nye County Application - Additional Veteran (pdf)
Nye County Application for Assistance - NEW 3-21 (pdf)
Rental Verification Form (pdf)
Security Deposit Letter (pdf)
Self Employment Form (pdf)
Utility Letter - Past Due (pdf)
VEA Pre-Pay Letter (pdf)
W-9 and Vendor Form (pdf)
Assistance Application Guidelines
Forms and Documents
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