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If you currently reside outside of the state of Kentucky, please click here for state specific information.

*Secondary Caregiver information will be optional. However, if the Family Structure is Married or Unmarried Couple or any of the fields in the Secondary Caregiver section are entered/selected, then all the requirements that exist for Primary Caregiver will apply to Secondary Caregiver.


Primary Caregiver
Yes No
Female Male
Yes No
Secondary Caregiver
Yes No
Female Male
Yes No
Household Address