- TO:
- ALL COUNTY OFFICES
- FROM:
- ALYSON CAMPBELL, DIRECTOR
- SUBJECT:
- IMPORTANT INFORMATION ABOUT ELECTRONIC BENEFIT TRANSFER (EBT) TRANSACTIONS FORM
- FORMS MANUAL REVISION #14
DISCUSSION:
The purpose of this memorandum is to introduce the form Important Information About Electronic Benefit Transfer (EBT) Transactions (IM-3EBT). The IM-3EBT form and instructions are available in the IM Forms Manual Volume I.
Use the IM-3EBT to provide a signed statement to the Family Support Division from applicants/participants acknowledging the following:
MISUSE OF YOUR FOOD STAMPS BENEFITS IS A VIOLATION OF STATE AND FEDERAL LAWS and/or MISUSE OF YOUR TEMPORARY ASSISTANCE BENEFITS IS A VIOLATION OF STATE AND FEDERAL LAWS
Provide a copy of the form for all individuals with an EBT card or those who will receive an EBT card during the following occasions:
- Face-to-face interviews;
- In person EBT card replacement request;
- When completing an in-person mid-certification review or Temporary Assistance review, and
- When discussing replacement EBT cards due to continued replacement request.
The IM-3EBT does not have to be mailed to the applicant/participant for applications, recertifications, or reviews when the interview is completed by phone, but the information on the form should be reviewed with the individual during the interview. Make a comment on the Eligibility Unit Member Role (EUMEMROL/FM3Z) screen stating when the IM-3EBT form is provided to an applicant/recipient or reviewed over the phone.
NECESSARY ACTION:
- Review this memorandum with appropriate staff.
AC/cb