Fill in a Valid Apply For Food Stamps In Missouri Template
Applying for food assistance can be a crucial step for many families and individuals facing financial challenges. In Missouri, the process begins with the Application for Supplemental Nutrition Assistance Program (SNAP), commonly known as food stamps. This form is designed to collect essential information about your household, including your name, address, and contact details, which are vital for the Family Support Division (FSD) to process your application efficiently. Applicants can submit the form via email, mail, or fax, and if an interview is required, it can often be conducted over the phone. It's important to note that benefits may be provided from the date the FSD receives your application, so timely submission is key. The form also includes sections that help expedite the process, such as questions about your household's income and expenses. Additionally, applicants can designate an authorized representative to assist with the application or manage benefits on their behalf. Throughout the application, there are specific questions that address household composition, income sources, and even potential disqualifications based on past convictions related to SNAP benefits. Understanding these aspects can make the application process smoother and help ensure that those in need receive the support they require.
Apply For Food Stamps In Missouri Preview
Missouri Department of Social Services
FAMILY SUPPORT DIVISION
Application for Supplemental Nutrition Assistance Program (SNAP)
To apply: You have the right to apply for SNAP benefits at any time.
•Benefits are provided from the date Family Support Division (FSD) receives your application which must contain your name, address and signature. Please complete sections 2 through 6 to help FSD process your application faster.
•You can email, mail, or fax your application. If an interview is required, it can be completed by phone. Family Support Division will attempt to call you, if you provided a phone number on the application, the next business day after your application is registered to complete an interview. If you did not provide a phone number, or if you are unable to complete your interview at the time we call, please call 855 823 4908 to complete your interview or visit an FSD office to complete this as soon as possible. We may ask you for proof of some of the information you give to FSD.
Date of application: : If approved, your SNAP benefits are provided from the date FSD receives your application. This is your filing date. If you are in an institution and apply for SNAP benefits and Supplemental Security Income (SSI) at the same time, your filing date is the date of release from the institution.
Authorized Representative: You can choose more than one person or facility to complete your application and/or manage your benefits on your behalf. They will act as your authorized representative. If you want an authorized representative, complete the Authorized Representative Form
Section 1 – Tell us about yourself
Your full name (first, middle, last):__________________________________________________________ |
I am homeless |
Home address (street, city, state, zip): ______________________________________________________________________________
_____________________________________________________________________________ County:________________________
Mailing address, if different: ______________________________________________________________________________________
_____________________________________________________________________________ |
County:________________________ |
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Phone 1: __________________________ |
Cell |
Home |
Work |
Other |
Phone 2: __________________________ |
Cell |
Home |
Work |
Other |
The best way to contact you:
Call
Email
Mail
Text (not available everywhere)
UNDER THE LAWS OF THE STATE OF MISSOURI, AND THE REGULATIONS OF THE UNITED STATES DEPARTMENT OF AGRICULTURE, I HEREBY APPLY FOR SNAP BENEFITS.
Your signature: ____________________________________________________ Date: _________________________
Section 2 – Key questions for faster service
If eligible, you will receive your benefits within 7 days of filing your application if you answer “yes” to any of the questions below. Otherwise, you will receive your benefits within 30 days of filing your application.
1. |
Does your household expect to receive less than $150 in income this month and have |
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$100 or less available in cash and/or in a bank account? |
Yes |
No |
2. |
Does your household have rent/mortgage and/or utility costs that are more than your |
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total income, available cash, and bank accounts for this month? |
Yes |
No |
3. |
Does your household include a migrant or seasonal farm worker whose income |
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has stopped and whose available cash and bank accounts do not exceed $100? |
Yes |
No |
Help FSD verify your identity for faster service. FSD will try to verify your identity electronically. Please (1) include a copy of your identification with your application, or (2) bring someone such as a friend, family member, landlord, or employer to any FSD office, or (3) list a contact below in order to help us verify your identity. FSD will call this person if needed.
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Name of person to |
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Phone |
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verify your identity: |
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Number: |
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Section 3 - Household members
Write your information on line 1. Enter the information of all the people who live in your household, including your spouse, any children under age 22 who are in your household at least half (50%) of the time, and anyone who eats the majority of their meals in your household. Include all household members regardless of their citizenship or immigration status.
Citizenship or immigration status does not automatically disqualify an applicant from receiving SNAP benefits. Racial and ethnic information is collected to assure that program benefits are distributed without regard to race, color, or national origin. Providing this information is optional and does not affect your eligibility or the amount of SNAP
benefits you receive.
Providing the Social Security Number (SSN) and immigration status of each household member is voluntary. However, you will not receive SNAP benefits for individuals who do not provide a SSN and/or immigration status. Immigration status of applicant household members may be subject to verification by U.S. Citizenship and Immigration Services (USCIS). Information provided by USCIS may affect your eligibility and benefit level.
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Full Legal Name |
Sex |
Relationship |
Date of birth |
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SSN |
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Hispanic or |
Race |
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to applicant |
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Latino? |
* |
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Self |
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*List ALL that apply: |
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**Not required for SNAP |
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1 - White |
2 - Black/African American |
3 - American Indian/Alaska Native |
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eligibility determination |
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4 - Asian |
5 - Native Hawaiian/Pacific Islander |
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If you do not have enough space for all household members, attach an additional list with their information.
1.Do you and all the people in your household buy and eat (cook) meals together?
Yes
No
If no, who does not buy and eat (cook) with your household? ___________________________________________
2.List anyone who is a boarder in your household: _______________________________________________________
3.List anyone who is a foster child or foster adult in your household: ________________________________________
4.List anyone who is not a U.S. citizen in your household: _________________________________________________
5.Is English your preferred language?
Yes
No
If no, what is the language spoken most often in your home? ____________________________________________
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Section 4 - Household declarations
Answer “yes” or “no” to each of the questions in this section. For each question you answered “yes,” explain in the space provided. A “yes” response to any of the questions in this section may result in a disqualification for SNAP
benefits for the person in which the “yes” answer applies.
1. |
Have you or any member of your household been convicted of buying or selling SNAP |
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benefits of $500 or more after |
Yes |
No |
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If yes, who? _________________________________________________________________ |
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2. |
Are you or any member of your household hiding or running from the law to avoid prosecution, |
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custody, or jail for a crime (or attempted crime) that is a felony? |
Yes |
No |
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If yes, who? _________________________________________________________________ |
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3. |
Are you or any member of your household violating a condition of probation or parole? |
Yes |
No |
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If yes, who? _________________________________________________________________ |
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4. |
Have you or anyone in your household made false statements about your identity or address |
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to receive SNAP benefits in 2 or more households at the same time? |
Yes |
No |
If yes, who? _________________________________________________________________
5.Have you or any member of your household been convicted in a federal or state court of a felony committed after
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substance? |
Yes |
No |
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If yes, who? _________________________________________________________________ |
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6. |
Have you or any member of your household ever been convicted of fraudulently receiving |
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duplicate SNAP benefits in any state after |
Yes |
No |
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If yes, who? _________________________________________________________________ |
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7. |
Have you or any member of your household been convicted of trading SNAP benefits for |
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guns, ammunitions, or explosives after |
Yes |
No |
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If yes, who? _________________________________________________________________ |
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Have you or any member of your household ever been convicted of trading SNAP benefits |
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for drugs after |
Yes |
No |
If yes, who? _________________________________________________________________
Section 5 - Household information
Answer these questions for yourself and all of the people who live with you (as listed in Section 3). |
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1. Has anyone received SNAP benefits in a state other than Missouri within the past 30 days? |
Yes No |
If yes, who? _________________________________ State: ____________________________ |
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2.Is anyone disabled?
Yes
No
If yes, who? _____________________________________________________________________
3.Is anyone age 18 to 49 and enrolled in school?
Yes
No
If yes, who? |
_________________________________ |
School: ___________________________ |
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If yes, who? |
_________________________________ |
School: ___________________________ |
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Page 3 of 8 |
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Resources
Resources are bank accounts and other types of money you own by yourself or with other people.
1. |
Does anyone have a bank account or is anyone’s name on a bank account? |
Yes |
No |
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If yes, who? _________________________ |
Balance: $ ____________ |
Bank name: ______________________ |
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If yes, who? _________________________ |
Balance: $ ____________ |
Bank name: ______________________ |
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Does anyone have any other cash? Yes No |
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If yes, who? _________________________ |
Balance: $ ____________ |
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If yes, who? _________________________ |
Balance: $ ____________ |
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Does anyone have stocks, bonds, and/or retirement accounts such as an IRA? |
Yes |
No |
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If yes, who? _________________________ |
Cash Value: $ ______________ |
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If yes, who? _________________________ |
Cash Value: $ ______________ |
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Income
Income is money that’s paid to you, such as earnings from a job or payments from Social Security or child support.
1.Does anyone earn income or money from working?
Yes
No
If yes, list who gets it, their employer, and monthly gross income before taxes or deductions:
Who earns income from working? |
Employer |
Monthly amount |
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$ |
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$ |
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$ |
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2.Does anyone receive income or money from the following sources?
Yes
No If yes, check the source and list who gets it and the monthly amount:
Source |
Who gets it? |
Monthly amount |
Social Security Income (Retirement, |
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$ |
Disability or Survivor’s) |
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Supplemental Security Income (SSI) |
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$ |
Veteran’s Administration (VA) |
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$ |
benefits |
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Child support |
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$ |
Unemployment benefits |
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$ |
Gifts or donations |
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$ |
Student loans, grants, scholarships |
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$ |
Other |
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$ |
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$ |
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3.Has anyone’s income stopped or been reduced in the last 30 days?
Yes
No
If yes, whose? _______________________________ Date and amount of last check _______________________ |
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Expenses
Expenses are the bills you are responsible for paying.
1. |
Does anyone pay rent or a house payment for the home you live in? Yes No |
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If yes, list the total monthly amount: $ ___________________ Who pays?____________________________ |
2. |
Does anyone pay the following utility expenses for the home you live in? (check all that apply) |
Electric: |
Does it heat or cool your home? |
Yes |
No |
Who pays? |
________________________ |
Gas: |
Does it heat or cool your home? |
Yes |
No |
Who pays? |
________________________ |
Other fuel: |
Does it heat or cool your home? |
Yes |
No |
Who pays? |
________________________ |
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List the fuel: _______________________________ |
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Phone |
Who pays? ________________________________ |
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Trash |
Who pays? ________________________________ |
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Water |
Who pays? ________________________________ |
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Sewer |
Who pays? ________________________________ |
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3. |
Does anyone pay |
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If yes, list the total monthly amount: $ ________________________________ |
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4. |
Does anyone who is either disabled or age 60 and older have medical expenses such as insurance |
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or Medicare premiums, doctor visits, |
Yes No |
If yes, list the total monthly amount: $ ________________________________
Section 6 ‑ Notices (Please read and sign page 8)
USDA
any program or activity conducted or funded by USDA. Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800)
To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form (AD- 3027) found online at: http://www.ascr.usda.gov/complaint_filing_cust. html, and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the information requested in the form.
To request a copy of the complaint form, call (866)
mail: U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, SW,
Washington, D.C.
DSS
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FSD FAIR HEARING RIGHTS: You have the right to a hearing if you have applied for or are receiving SNAP benefits, and the following happens:
•FSD decides that you are not eligible and you think you are.
•FSD provides you with SNAP benefits and then reduces or stops the benefits and you think the reasons are wrong.
•You disagree with the information used to determine the benefit amount or disagree with the benefit amount.
•FSD refuses to take your application.
•FSD does not act promptly on your request for help and you think that they have had enough time to do so.
If your application has been refused or rejected or any action on your case has already been taken, you may request a hearing within 90 days of the refusal or action. If the proposed action will change or stop your benefits and you request a hearing within ten days from the date of the notice, you may continue to receive the same benefits until the hearing decision. You or your representative may request a hearing by phone,
YOU MAY BE DISQUALIFIED FROM RECEIVING SNAP BENEFITS IF YOU:
•Sell your SNAP benefits for cash or consideration other than eligible food, either directly, indirectly, in complicity or collusion with others, or acting alone.
•Lie or hide information to get SNAP benefits that your household should not get.
•Use SNAP benefits to buy nonfood items, such as alcohol or cigarettes, or to pay on credit accounts.
•Purchase a product with SNAP benefits that has a container requiring a return deposit with the intent of obtaining cash by discarding the product and returning the container for the deposit amount.
•Intentionally purchase products with SNAP benefits in exchange for cash. For example, do not purchase food to make products for resale.
•Pay for food purchased on credit with SNAP benefits.
•Use or have in your possession EBT cards that are not yours.
•Trade or sell EBT cards or provide food purchased with SNAP benefits to
NOTIFICATION AND ACKNOWLEDGEMENT OF FRAUD PROVISIONS
It is against the law to lie to receive SNAPs or to sell or trade your SNAP benefits. Excessive Electronic Benefit Transfer (EBT) card replacement requests may result in a referral for fraud investigation. 7 USC 2015(b)(1) any person who has been found by any state or federal court or administrative agency to have intentionally made a false or misleading statement, or misrepresented, concealed or withheld facts or committed any act that constitutes a violation of this act, the regulations issued thereunder, or any state statute, for the purpose of using, presenting, transferring, acquiring, receiving, or possessing SNAP benefits shall, immediately upon the rendering of such determination, become ineligible for further participation in the program for a period of 1 year upon the first occasion of any such determination, 2 years for the second occasion and permanently upon the third occasion.
Applicants cannot violate the Food and Nutrition Act of 2008 which includes the following:
•Any member who breaks any of the rules on purpose can be ineligible from the SNAP Program for one year, up to permanently, fined up to $250,000, imprisoned up to 20 years or both. S/he may also be subject to prosecution under other applicable Federal and State laws. S/he may also be barred from SNAPs for an additional 18 months if ordered by a court.
•Any member of your household who intentionally breaks the rules may be ineligible to receive SNAPs for one year for the first offense, two years for the second offense, and permanently for the third offense.
•If a court of law finds any household member guilty of using or receiving benefits in a transaction involving the sale of a controlled substance, you will not be eligible for benefits for two years for the first offense, and permanently for the second time.
•If a court of law finds you guilty of having used or received benefits in a transaction involving the sale of
•If you are found to have made a fraudulent statement or representation with respect to the identity or place of residence in order to receive multiple SNAP benefits simultaneously, you will be ineligible to participate in the Program for a period of 10 years.
•If a court of law finds you guilty of having trafficked benefits for an aggregate amount of $500 or more, you will be permanently ineligible to participate in the Program upon the first occasion of such violation.
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The information you provide on the application will be subject to verification by Federal, State or local officials to determine if the information is factual; that if any information is incorrect, SNAP benefits may be denied and you may be subject to criminal prosecution for knowingly providing incorrect information.
Information available through the Income Eligibility and Verification System (IEVS) will be requested, used and may be verified through collateral contacts when discrepancies are found by the State, and that such information may affect the household’s eligibility and level of benefits.
The collection of information on the application, including the SSN of each household member, is authorized under the Food and Nutrition Act of 2008 (formerly the SNAP Act), as amended, 7 USC
Pursuant to Section 570.030, RSMo, the stealing of public assistance benefits is a Class C felony if the value of the benefits is $500.00 or more (after 1/1/17 is a Class D felony and value is $750.00 or more). Punishment includes imprisonment for up to seven years and a fine not to exceed $5,000.00. If the value of the benefits is less than $500.00, the crime is a Class A misdemeanor (after 1/1/17 less than $750.00). Punishments and fines may increase for repeat offenders.
Pursuant to Section 578.377 (570.400 effective 1/1/17), RSMo, unlawful receipt of public assistance benefits or EBT cards, you understand that it is against the law to obtain or attempt to obtain SNAP benefits to which you are not entitled, or obtain, or attempt to obtain SNAP benefits in the amount greater than those to which you are entitled.
YOU UNDERSTAND THAT ANY FALSE CLAIM, STATEMENT, OR CONCEALMENT OF ANY MATERIAL FACT WHATSOEVER, IN WHOLE OR PART, ON THIS FORM OR DURING THE INTERVIEW, MAY SUBJECT YOU TO CRIMINAL AND/OR CIVIL PROSECUTION. You will be asked to complete an interview with the Family Support Division to complete this application process. You will be required to provide proof of some of the information you provide on this application and/or in the interview. Your signature acknowledges that you agreed to the terms outlined in this application and during the interview.
WORK REGISTRATION
I understand and agree that to receive SNAPs, certain members of the household need to register for work. This means that certain members of the household must: A) Register for work at time of application and recertification.
B)Not quit a job of 30 or more hours/week without good cause. C) Not reduce work hours under 30 hours per week without good cause. D) Not refuse to accept a bona fide offer of suitable employment without good cause. Anyone who does not follow the work requirements may be disqualified from receiving SNAPs. This form also acts as a work registration notice. You, along with other nonexempt household members, will be considered work registered and must comply with the requirements associated work registration once this form is signed.
WORK AND/OR TRAINING REQUIREMENT (ABAWD)
Individuals identified as Able Bodied Adults Without Dependents (ABAWD’s) are not eligible to participate in the SNAP Program as a member of any household if the individual received SNAP benefits for three countable months during
a three year period from January 2016 to December 2018. Countable months are months during which an individual receives SNAP benefits for the full benefit month while not fulfilling the work requirement by working and/or attending training 20 hours per week, averaged monthly for a total of at least 80 hours.
An ABAWD is
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READ THIS PAGE CAREFULLY BEFORE SIGNING.
When you sign, you are certifying you understand the statements on this application. You are certifying, under penalty of perjury, you understand the information that you provide on this form and during the interview must be true and accurate, including information concerning citizenship and immigration status. You understand that any expenses you do not report, and verify when requested, will not be used to determine your SNAP benefits.
You are authorizing the Director of Family Support Division or his/her appointee to verify your circumstances and statements via Federal, State or local officials to determine if the information you provided is factual.
Pursuant to Section 578.385 (570.408 effective 1/1/17), RSMo, under the penalty of perjury, you certify that you have given true, accurate, and complete statements to the best of your knowledge, for each household member for whom you are applying including the information concerning citizenship and alien status.
By signing this application on paper or electronically, you are giving us permission to deliver, or cause to be delivered phone calls to you regarding your case from an automated dialing system at the primary phone number you provided on page 1. You do not have to consent to this as part of your application. If you want to opt out of getting these calls, check here:
⬇SIGN HERE:
Your signature:
Date:
Signature of witness (needed if you cannot sign your name):
Date
Need help?
•Visit https://dss.mo.gov to start a chat, check the status of your benefits, or report changes
•Call
•Relay Missouri 711
•TTY users can call
If you are blind or visually impaired and would like information about rehabilitation services for the blind, please call
Establishing paternity is not required for SNAP benefits. However, if you want assistance in establish- ing paternity, please contact the FSD Paternity Hotline at
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Common PDF Templates
Missouri Rent Rebate - Instructions for assessors are included within the form.
Tobacco License Missouri - Cigarette vending machine and humidor locations must be documented on the form.
St Louis County Local Rules - The form is a foundation for nurturing positive parent-child relationships.
Dos and Don'ts
When filling out the Apply For Food Stamps in Missouri form, there are important steps to follow. Here’s a list of things you should and shouldn’t do:
- Do provide accurate information. Ensure that all details, including your name, address, and household members, are correct.
- Do include all household members. List everyone who lives with you, regardless of their citizenship status.
- Do submit your application promptly. Send your application as soon as possible to avoid delays in receiving benefits.
- Do follow up for an interview. If contacted for an interview, respond quickly to complete the process.
- Don’t leave sections blank. Fill out all required sections to prevent processing delays.
- Don’t provide false information. Misrepresentation can lead to disqualification from benefits.
- Don’t forget to sign your application. An unsigned application is not valid and will not be processed.
- Don’t ignore requests for additional information. If asked for proof or clarification, respond promptly to avoid delays.
Key takeaways
Applying for food stamps in Missouri can be straightforward if you keep a few key points in mind. Here are some essential takeaways to help you navigate the process effectively:
- Right to Apply: You can apply for SNAP benefits at any time. Your benefits will start from the date the Family Support Division (FSD) receives your application.
- Complete Your Application: Fill out sections 2 through 6 thoroughly. This will help FSD process your application more quickly.
- Submission Methods: You can submit your application via email, mail, or fax. If an interview is necessary, it can often be done over the phone.
- Interview Process: If you provided a phone number, FSD will attempt to call you the next business day after your application is registered. If you miss the call, reach out to them at 855-823-4908.
- Authorized Representatives: You can appoint someone to help you with your application or manage your benefits. This person must be designated on the Authorized Representative Form.
- Proof of Information: Be prepared to provide proof of the information you give on your application. FSD may need to verify your identity or other details.
- Eligibility Questions: Answer the key questions in Section 2 carefully. If you qualify based on your responses, you could receive benefits within 7 days.
By keeping these takeaways in mind, you can make the process of applying for food stamps in Missouri smoother and more efficient. Good luck!
Misconceptions
- Misconception 1: You can only apply for food stamps during specific times of the year.
- Misconception 2: You need to provide extensive documentation to apply.
- Misconception 3: You must have a phone to complete your application.
- Misconception 4: Citizenship status automatically disqualifies you from receiving benefits.
- Misconception 5: You will not receive benefits if you have been convicted of a crime.
This is incorrect. You have the right to apply for SNAP benefits at any time. Your application will be processed as soon as it is received by the Family Support Division (FSD).
While some proof may be required, the application process is designed to be straightforward. You only need to include basic information such as your name, address, and signature, along with some key questions to expedite processing.
Although providing a phone number can speed up communication, it is not mandatory. You can still apply via email, mail, or fax, and you can visit an FSD office if needed.
This is not true. Citizenship or immigration status does not disqualify applicants from receiving SNAP benefits. However, providing a Social Security Number (SSN) is necessary for individuals who wish to receive benefits.
While certain convictions can affect eligibility, not all crimes disqualify you from receiving SNAP benefits. The specifics depend on the nature of the offense and when it occurred.
Similar forms
The "Apply For Food Stamps In Missouri" form is similar to several other important documents that help individuals access various forms of assistance. Here are eight documents that share similarities with this application:
- Medicaid Application Form: Like the food stamps application, this form collects personal information and income details to determine eligibility for healthcare assistance. Both require proof of identity and residency.
- Temporary Assistance for Needy Families (TANF) Application: This application also gathers information about household members and income to assess eligibility for cash assistance. It includes questions about expenses and resources, similar to the food stamps form.
- Supplemental Security Income (SSI) Application: This form is used to apply for financial assistance for individuals with disabilities. It requires personal and financial information, much like the food stamps application.
- Low-Income Home Energy Assistance Program (LIHEAP) Application: This document helps households apply for help with energy costs. It asks for income and household information, akin to the food stamps application.
- Women, Infants, and Children (WIC) Program Application: The WIC application assesses eligibility for nutritional support for mothers and young children. It collects similar demographic and income information.
- Housing Assistance Application: This form is used to apply for subsidized housing. It requires details about household composition and income, paralleling the information needed for food stamp eligibility.
- Child Care Assistance Application: This application gathers information about income and family size to determine eligibility for child care subsidies. The structure and required information are similar to the food stamps application.
- Unemployment Benefits Application: This form is used to apply for financial assistance when unemployed. It asks for personal information, work history, and income, mirroring the food stamps application process.