County Assistance Application

Non-Medical Assistance

Use this form only for assistance with:

  • Electric Bills
  • Heating Bills
  • Cremation/Burial
  • Rent
  • Utilities
  • Water Bills
  • Generic Medication (Restrictions Apply)

Download the application for all non-medical (PDF). You cannot submit your application on-line! You must print the completed application, sign it and file it with the Kootenai County Assistance Office.

Medical Assistance

Use this form only for assistance with:

  • Non-Emergent Medical Bills

Please note that the medical application does require a lot of information. This is required by state law as all applications received by County Assistance are shared with the Department of Health and Welfare to determine if the applicant is eligible for Medicaid payment of the medical services. Thank you for your patience and please be sure to complete the entire application (PDF).

Note

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