Appendices

Produced by Patricia Baker and Victoria Negus
Reviewed January 2016

Appendix A: SNAP Worksheets

pdf icon SNAP Benefits Worksheet - Fillable PDF
Online SNAP Calculator

Appendix B: Income and Benefits Standards

pdf icon Income and Benefit Standards

Appendix C: SNAP Advocacy and DTA Documents

Important SNAP Advocacy and DTA Documents

pdf icon DTA FAX Cover Sheet (to send documents to Document Management Center)
pdf icon Sample Client Consent Allowing DTA to Release Information to Helping Agency
pdf icon Request to Choose Someone to be my Authorized Representative
pdf icon Request for an Appeal (Fair Hearing)
pdf icon Request to Employer for Employment Information (DORL-1)
pdf icon Community College Verification Form (CCE-1)
pdf icon College Educational Income and Expense Form EDUC-1
pdf icon Loss of Food/Household Misfortune Form for Replacement SNAP

Able-bodied Without Dependent (ABAWD) Fliers and Forms

pdf icon DTA ABAWD Medical Report Form
pdf icon DTA ABAWD Homeless Screening Form
pdf icon DTA Work Program Community Service Participation form
pdf icon MLRI FAQ on the SNAP time limit for ABAWDs

MLRI Know Your Rights Fliers and Client Materials

pdf icon Dependend Child Care Deduction and Sample Declaration
pdf icon Sample Client Declaration of Shelter Costs
pdf icon SNAP Medical Expense Deduction and Screening Form
pdf icon Adult and Child Foster Care Households

pdf icon College Student Eligibility
pdf icon SNAP Misfortune Replacement Benefits Power Outage/Food Loss
pdf icon 3 Things You Need to Know about Photo EBT Cards

Appendix D: Cash and Food Stamp/SNAP Benefits for Noncitizens

pdf iconEligibility Charts by Immigration Status
pdf iconSample Calculations for "Mixed Status" Households
pdf iconDTA Brochure: What Noncitizens Need to Know

Appendix E: Legal Services

pdf icon Legal Services Office Listings
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