General Intake Sheet (GIS) – How to Apply for Assistance

Click Here to download the form.

What is this form?

The General Intake Sheet is the main application form you fill out when you need help from the Provincial Social Welfare and Development Office (PSWDO). Whether you need money for medical bills, funeral costs, school fees, food, or other emergencies, this is the form you start with.

What kind of help can you get?

  • Medical bills and medicines
  • Funeral and burial expenses
  • School fees and supplies
  • Transportation costs
  • Food assistance
  • Emergency cash support
  • Food packs, blankets, hygiene kits, and other items
  • Counseling and support services

How to fill out the form

Step 1: Your Basic Information

  • Write today’s date and the time you arrive
  • Check if this is your first time applying (New), if you’ve applied before (Returning), or if someone referred you

Step 2: Your Personal Details

  • Full name, birthdate, age, and gender
  • Phone number
  • Complete address (house number, barangay, city, province)
  • What you do for work and how much you earn per month
  • Your civil status (single, married, widowed, etc.)

Step 3: Is Someone Applying for You?

  • If a family member or representative is applying on your behalf, fill in their name and how they’re related to you

Step 4: Who Are You? Check the box that describes you (or your situation):

  • Senior Citizen
  • Person with Disability (PWD)
  • Solo Parent
  • Indigenous Person
  • Person Living with HIV (PLHIV)
  • Street Dweller
  • 4PS Beneficiary (Pantawid Pamilya)
  • Other (describe)

Step 5: Your Family Members List everyone living with you and provide:

  • Their name
  • How they’re related to you
  • Age
  • What they do for work (if any)
  • How much they earn per month

Example:

NameRelationAgeWorkIncome
Maria SantosSpouse45Housewife₱0
Juan Jr.Son18Student₱0

Step 6: What Kind of Help Do You Need? Check all that apply:

  • ☐ Money for medical bills
  • ☐ Money for funeral/burial
  • ☐ Money for transportation
  • ☐ Money for school
  • ☐ Food assistance
  • ☐ Emergency cash
  • ☐ Food packs
  • ☐ Blankets and hygiene kits
  • ☐ Counseling or support

Step 7: Bring Your Documents The PSWDO staff will check what documents you brought. Make sure you have:

Always bring:

  • Barangay Certificate of Indigency (from your barangay)
  • Valid ID (driver’s license, passport, PhilHealth card, etc.)

For medical help:

  • Doctor’s certificate or medical abstract
  • Hospital bill or charge slip

For funeral help:

  • Funeral contract
  • Death certificate

For school help:

  • School enrollment certificate
  • School ID

If you’re a 4PS beneficiary:

  • Your 4PS card

Important Reminders

✅ Do this:

  • Write clearly and legibly
  • Fill in all the blanks
  • Be honest about your family’s income and situation
  • Bring all your documents
  • Sign the form at the bottom

❌ Don’t do this:

  • Leave blank spaces
  • Give false information (you could be disqualified or face legal action)
  • Forget your valid ID and supporting documents

What happens next?

  1. A social worker will review your form and documents
  2. They will talk with you to understand your situation better
  3. If you qualify, you’ll get an approval document showing what help you’ll receive
  4. You’ll sign a receipt confirming you got the assistance

Need help?

If you have questions while filling out the form, or need assistance, visit us:

Provincial Social Welfare and Development Office (PSWDO)
Provincial Capitol, Pratt St. Zone 5, Bangued, Abra
📧 Email: pswdo@abra.gov.ph

Office Hours: Monday–Friday, 8:00 AM – 5:00 PM