Forms


The forms below can be used when providing relevant information to the Department. The fillable forms can be completed online and may need to be printed for signature. Once completed, the forms should be sent to the relevant email address. 

ONLINE APPLICATION
New
Application Form for Financial Assistance

This application and all supporting documentation should be completed and submitted when requesting financial assistance.

New
Release of Information

This form needs to be completed by the applicant for financial assistance and each householder member. The intention of this document is to facilitate the delivery of financial assistance by providing authorization for the Department of Financial Assistance to communicate with external organizations.

New
Authorization of Representative

This form must be completed where a representative will be applying for financial assistance or communicating with the Department on behalf of an applicant, recipient or member of a household.

Application and Assessment 
New
Eligibility Self-Assessment

This form can be completed to determine if you may qualify for financial assistance.

New
Application Documentation List

Outlines the documents required to be submitted when applying for financial assistance or when circumstances of an applicant, recipient or household change

New
Application Form for Financial Assistance

This application and all supporting documentation should be completed and submitted when requesting financial assistance.

New
Application for Financial Assistance - Appendix 1

Appendix 1 is to be completed for additional adult members of the household. If there are multiple adult household members, this form should be completed once per household member.

New
Application for Financial Assistance - Appendix 2

Appendix 2 is to be completed for additional members of the household who are under 18 years of age. If there are multiple household members who are under 18 years of age, this form should be completed once per household member.

New
Release of Information

The intention of this document is to facilitate the delivery of financial assistance by providing authorization for the Department of Financial Assistance to communicate with external organizations.

New
Authorization of Representative

This form must be completed where a representative will be applying for financial assistance or communicating with the Department on behalf of an applicant, recipient or member of a household.

New
External Organization Referral for Emergency Circumstances

This form can be used by an external organization to provide support for an applicant who is applying for financial assistance due to emergency circumstances.

New
Medical Form

The purpose of this document is for a medical doctor or medical officer to inform the Department of Financial Assistance whether an individual is able to work, or if they have a temporary or permanent disability.

New
Reconsideration Form 

This form may be completed by an applicant or recipient for financial assistance who is aggrieved by a decision from the Department of Financial Assistance and who seeks a reconsideration of that decision.

Representative
New
Authorization of Representative

This form must be completed where a representative will be applying for financial assistance or communicating with the Department on behalf of an applicant, recipient or member of a household.

New
Revoke Authorization of Representative

This form is to be used by an applicant, representative or household member who has authorized a representative for their interactions with the Department of Financial Assistance and would like to revoke that authorization. If a new representative is to be assigned, an Authorization of Representative Form should also be submitted for the new request.

Case Management
New
Request Change in DFA Assigned Officer Form

This form is for someone who would like to request a change to their assigned officer from the Department of Financial Assistance.

New
Conditions Monitoring

This form can be used by external organizations to assist the Department of Financial Assistance in monitoring conditions placed on recipients. 

New
Continuation Certificate

This form can be used by older persons and/or adults who are unable to work due to having a permanent disability, who are recipients of financial assistance to renew their services in the following circumstances: 1. The household has only older persons and/or adults who are unable to work due to having a permanent disability. 2. There are no household members who are able to work. 3. Your household’s circumstances have not changed since your last assessment for financial assistance. 4. No other services are being requested.

New
Change in Circumstances

This form is for an applicant, recipient or household member to notify the Department of Financial Assistance about a change in circumstance within the household. A change in circumstance is anything which could affect a household’s eligibility or receipt of financial assistance, whether temporary or permanent. Where proof of the change of circumstance is available, it must be submitted with this form.

New
Referral from DFA to External Organization

This form is for the Department of Financial Assistance to refer an applicant, recipient or household member of financial assistance to another community organization.

New
Document Requisition Form

This form can be used by an applicant or a recipient to request documents and or letters from the department.

New
Conditions Monitoring Form (2)
This form can be used by WORC to assist the Department of Financial Assistance in monitoring conditions placed on recipients.
Seafarers and Veterans Ex-Gratia Benefit 
New
Application Form for Caymanian Seafarer Ex-Gratia Benefit

This form must is to be completed in order to apply for the Seafarer Ex-Gratia Benefit.

New
Release of Information – Seafarers/Veterans

This form needs to be completed by Seafarer, Veterans, or their surviving spouse for financial assistance and each householder member. The intention of this document is to facilitate the delivery of financial assistance by providing authorization for the Department of Financial Assistance to communicate with external organizations.

Complaints
New
MIISD Complaint Policy 

Sign In to complete online form

This policy outlines the policy and process for the handling of internal complaints received by the Ministry of Investment, Innovation and Social Development, and its Departments. 
New
MIISD Complaint Form

Sign In to complete online form

This form can be used to file a complaint against a staff of the Ministry of Investment, Innovation and Social Development and its Departments, including the Department of Financial Assistance. 

Complaints
New
MIISD Complaint Policy 
This policy outlines the policy and process for the handling of internal complaints received by the Ministry of Investment, Innovation and Social Development, and its Departments. 
New
MIISD Complaint Form
This form can be used to file a complaint against a staff of the Ministry of Investment, Innovation and Social Development and its Departments, including the Department of Financial Assistance. 

Forms

The forms below can be used when providing relevant information to the Department. The fillable forms can be completed online and may need to be printed for signature. Once completed, the forms can be uploaded here. 

Application and Assessment 
New
Eligibility Self-Assessment Guide
If you are applying for financial assistance, take the Eligibility Self-Assessment to see if you would qualify. 
New
Application Document Checklist
This outlines all of the documents that must be submitted with a complete application for financial assistance. 
New
Application for Financial Assistance 
Applications for financial assistance must be submitted online. This version of the form should only be used in cases of emergency or where the form is not working. 
New
Release of Information Form
This form is for applicants, recipients and household members to provide authorization for the Department to provide information to individuals or organizations as is relevant. A signed Release of Information Form must be submitted for each household member at the time of application. 
New
External Organization Referral to DFA for Emergency Circumstances 
This form can be used when someone is applying for financial assistance in an emergency circumstance by an external organization to provide more information to assist the Department of Financial Assistance to assess the application. 
New
Medical Form
The Medical Form is to be completed by a medical professional in circumstances where someone is applying for financial assistance due to a disability or medical condition. 
New
Reconsideration Form 
The Reconsideration Form can be utilised where an applicant or recipient is aggrieved by a decision made by the Department to request a reconsideration of the decision. 
Representative
New
Authorization of Representative Form 
This form is to be completed in every circumstance where someone is authorizing a representative to act on their behalf with the Department of Financial Assistance. 
New
Revoke Authorisation of Representative Form
This form can be used to revoke authorisation of a representative at any time. 
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Seafarers and Veterans Ex-Gratia Benefit 
New
Seafarers Ex-Gratia Benefits Policy
This policy outlines the eligibility criteria and important information to access the Seafarer’s Ex-Gratia Benefit. 
New
Seafarer Ex-Gratia Benefit Application Form 
This form can be utilised by Seafarer’s or the spouse of a deceased Seafarer to access the Ex-Gratia Benefit. 

Complaints
New
MIISD Complaint Policy 

Sign In to complete online form

This policy outlines the policy and process for the handling of internal complaints received by the Ministry of Investment, Innovation and Social Development, and its Departments. 
New
MIISD Complaint Form

Sign In to complete online form

This form can be used to file a complaint against a staff of the Ministry of Investment, Innovation and Social Development and its Departments, including the Department of Financial Assistance.