Benefits and Services Form   In order to help you learn about programs that provide benefits and services in Alabama, we want to ask you about your household. What you tell us on this form will let us know which benefits or services your household members may be able to get. We cannot promise that anyone in your household will get any benefits or services. If you decide you want to find out more or apply for these programs, we will help you. We will also help you print out a copy of your answers to take to the other program(s). If you want to learn more about these services, please read the following and check, "I agree."   Agreement   I understand and agree that: I am not applying for any services or benefits by completing this form. Completing this form does not mean that any household member will get benefits or services from any of the programs. I have to contact each program to find out more or apply for their benefits or services. Someone will help me when and if I need it. Each program will decide if any of my household members will get benefits or services. I understand that some programs may ask me to complete other forms, meet with them, or give them proof about my household information before anyone can get benefits or services.   I Agree I Disagree