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

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