Ontario Works Forms

Form Name Description
Birth Certificate Application

PDF file

Application form for Birth Certificate

Business Income and Expenses Report

PDF file

Business income and expenses for the Ontario Works program

Direct Deposit Form

Direct deposit form for the Ontario Works and Ontario Disability Support programs

Discretionary Benefits Request

PDF file

Application form for Discretionary Benefits

Employment and Participation Benefits Request Form

PDF file

Application form for Employment and Participation Benefits for the Ontario Works program

Exception-Based Income Reporting Request Form

PDF file

Exception-based income reporting request form

Homelessness Prevention Benefit Application

PDF file

Income Reporting Form - Change Statement

PDF file

Income reporting form for the Ontario Works program

Internal Review Request Form

PDF file

Internal Review request form for Ontario Works program

MyBenefits Handout

PDF file

Information on MyBenefits program

Ontario Works Child Care Receipt

PDF file

Reporting form for monthly child care costs

Ontario Works Document Checklist

PDF file

Documents required when applying for Ontario Works

Pay Direct Authorization Form

PDF file

Authorization form for Pay Direct

Rent Report

PDF file

Rent Report form for Ontario Works program

Special Diet Allowance Form

PDF file

Application form for Special Diet Allowance

Transportation Request Form

PDF file

Contact Us

United Counties of Leeds and Grenville
25 Central Ave. W, Suite 100,
Brockville, Ontario K6V 4N6

Telephone: 613-342-3840
Toll Free: 1-800-770-2170
TTY: 613-341-3854, 1-800-539-8685
Fax: 613-342-2101

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