Department of Social Services
Family Support Division
PO Box 2320
Jefferson City, Missouri
TO: ALL FAMILY SUPPORT OFFICES
FROM: KIM EVANS, DIRECTOR
SUBJECT: FOOD STAMP PROGRAM FORM IM-109 IN-HOME SERVICE PROVIDER AND DIVISION OF AGING PARTICIPANT EBT FOOD STAMP AGREEMENT
FORM REVISION #13
This memorandum is to notify staff, effective immediately, form IM-109 IN-HOME SERVICE PROVIDER AND DIVISION OF AGING PARTICIPANT EBT FOOD STAMP AGREEMENT is obsolete.
Participants wishing to appoint someone to make Food Stamp purchases on their behalf must complete the IM Authorized Representative (AR) form IM-6AR found in the IM Forms Manual Volume I.
Staff encountering cases where an AR was entered using the IM-109, should end date the AR entry and notify the participant that an AR form must be completed to allow someone else to access their benefits.
- Review this memorandum with appropriate staff.
- Destroy unused copies of this form and instructions.