Department of Social Services
Family Support Division
PO Box 2320
Jefferson City, Missouri
TO: ALL FAMILY SUPPORT OFFICES
FROM: KIM EVANS, DIRECTOR
SUBJECT: ELECTRONIC SIGNATURE ADDED TO REPLACEMENT REQUEST FORM IM-110 FOR SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP)
FORM REVISION #
The Replacement Request (IM-110) was updated with language to allow for an electronic signature. All SNAP replacement requests must be signed by an adult member of the household or an authorized representative to be considered valid.
In the Signature Section of the IM-110, there are new Electronic Signature Terms and Conditions with a check box for the participant to click and agree to sign the form digitally. If a participant chooses to submit the form without printing, the box under Electronic Signature Terms and Conditions must be checked and a name typed into the signature line for the signature to be valid. If the form is printed and submitted with a typed signature, the box above the signature line must be checked for the form to be considered signed.
The instructions on the back of the form have been updated with guidelines for Electronic Signatures. The IM-110 can still be printed, physically signed, and submitted by upload, fax or mail. This form is available in the public and internal forms manuals; however, it has been removed from the e-store.
• Review this memorandum with appropriate staff.
• Destroy all older (04/2022) versions of this form and begin using (7/2022) version immediately.