Appendix A: Applications/Renewal Chart, Forms to Distribute/Complete

NOTE: Other specialized forms may be necessary.

Type of Household

Application

Renewal

These Forms May Also Be Required as Applicable Miscellaneous

TANF/ETANF

PA 253 or PA 253RF
PA 600
PA 4 (Optional)
PW 764
PA 1661

PA 253 or PA 253RF
PA 600R
PA 4 (Optional)
PW 764
PA 1595
PA 1661

PA 635 or PA 586
PA/CS173WP

PA 1665

PA 1820
PA 1680
PA 1747

Length of period - 12 months - subject to semiannual reporting.

***See Chapter 104, Appendix A. for client information brochures

Updated September 24, 2025, replacing September 25, 2012