- TO:
- ALL COUNTY OFFICES
- FROM:
- ALYSON CAMPBELL, DIRECTOR
- SUBJECT:
- REVISED FOOD STAMP FORMS
- FORMS MANUAL REVISION #4
DISCUSSION:
The following changes are made to Food Stamp forms.
- The USDA nondiscrimination statement is revised to include additional protected groups.
- Additional instructions are given for filing a civil rights complaint.
- References to the DSS web application are removed.
- The declaration question concerning false statements about identity and household is revised for clarity.
The revised forms can be printed from the Forms Manual on the Family Support Division intranet or ordered from the warehouse. Destroy all versions with a revision date earlier than May 2014. The following forms are revised.
- FS1 – Application For Food Stamp Benefits (English and Spanish),
- IM31B – Your Rights As A Food Stamp Applicant/Participant,
- IM31F – Instructions For Making Your Food Stamp Application & Food Stamp Rights (English and Spanish),
- IM4 (Hearing Rights) – Important Information About Your Hearing Rights (English and Spanish), and
- IM4 (FS/SR) – Simplified Reporting For the Food Stamp Program
Additional forms will be revised as needed.
NECESSARY ACTION:
- Review this memorandum with appropriate staff.
AC/jm