Florida Food Stamp Application Form Pdf Download

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Do you have a reason that makes it difficult for you to come to the office for an interview? Date Stamp: ______________________ Application Illness Transportation Work or Training Live in a Rural Area Care for a sick or Disabled Household Member Other (explain): Case Number: I would like to apply for: Food Assistance Cash Relative Caregiver OSS/Optional State Supplementation Medical Medicaid Waiver/Home & Community Based Services Hospice Nursing Home Care – Living address prior to entering Nursing Home: EXPEDITED FOOD ASSISTANCE – Eligible households may receive food assistance benefits within 7 days Is your household’s gross income less than $150? YES NO Do you pay to heat or cool your home? YES NO A re your total liquid assets (such as cash, bank accounts, etc) less than $100? YES NO What is the monthly amount of your rent or mortgage? $ Is your household’s monthly gross income plus your total liquid assets less than your monthly rent or mortgage plus utilities? YES NO Has all of your household’s income recently stopped? If yes, WHEN? YES NO Check the bills you pay: Electricity Gas Water Sewage Phone Is anyone in your household a migrant or seasonal farmworker? If yes, WHO? YES NO APPLICANT INFORMATION Welcome to the Florida Department of Children and Families (DCF). If you need help in completing this application or need interpreter services, pl ease contact ACCESS Florida at 1-866-762-2237. We need at least your name, address, and a signature. Processing begins th e day we receive your signed application. House-hold members who are ineligible, or who are not applying for benefits, may be designated as non-applicants. Non- applicants, or persons applying only for Emergency Medicaid, Refugee Cash Assistance, or Refugee Medical Assistance, are NOT required to provide a Social Security Number (SSN) based on the Food Stamp Act. If you are not eligible for an SSN because of your immigration status , you may be eligible for a non-work SSN to receive the benefits that require one. If you need an SSN, we c an help you apply for one. Non-applicants are NOT required to provide proof of immigration status. Noncitizens who are applying for benefits will have their immigration status verified with the United States Citizenship and I mmigration Services (USCIS). We will not tell USCIS about the immigration status of those living in your household who are not applying f or benefits. Under no circumstances will individuals who are not applying for ben efits be reported as not lawfully residin g in the United States. If you are completing this application for someone else, ans wer the questions based on their circumstances. Name: First Middle Last Home or Message Phone Number: E-Mail Address: Home Address: Street Apt. No. City State Zip Code Work Phone Number: Address where you get your mail (if different from where you live): Street/P. O. Box City State Zip Code Cell Phone Number: INFORMATION FOR ALL PROGRAMS Has anyone in your home been convicted of a drug trafficking felony? Has anyone in your home ever been convicted of receiving food assistance, temporary cash assistance, or Medicaid in more than one state at the same time? Is anyone in your home fleeing the law due to a felony or a probation or parole violation? YES NO If yes, who? YES NO If yes, YES NO If yes, who? who? Did anyone in your home quit a job in the last 60 days or is anyone on strike? Has anyone in your home received food, cash, or medical assistance from another state or source in the last 30 days? Has anyone in your home sold or given away any property or assets in the last 5 years? YES NO If yes, who? YES NO If yes, YES NO If yes, who? who? STATEMENT OF UNDERSTANDING SIGNATURES I understand that information that I provide with this application, interview, or when requesting other benefits, including computer information matches with other agencies, is subject to verification by ______________________ _______________________________ DCF and other Federal and State agencies including Division of Public Assistance Fraud (DPAF). Signature of Adult Household Member Date Signed I understand and agree to the following: DCF, DPAF, and authorized Federal Agencies may verify the information I give on this form, interview, or when requesting other benefits. Information may ______________________ _______________________________ be obtained from my past or present employers. My signature authorizes release of such Signature of Witness if signed with an “X” information to DCF and/or DPAF. As a condition of participation in Medicaid, I consent to review and release of all medical records deemed necessary by Medicaid under its auditing and Authorized/Designated Representative – Print Name, Address, and Phone investigatory powers. If any information is incorrect, benefits may be reduced or denied and I may ____________________________________________________________ be subject to criminal prosecution or disqualified from the program for knowingly providing incorrect or false information or hiding information. I have read my Rights and Responsibilities. I certify ________________________ _____________________ _______________ under penalty of perjury that the information on this form is true to the best of my knowledge, including the citizen or noncitizen status of those who are applying for benefits. I hereby acknowledge receipt of the Florida DCF CFOP 60-17, Chapter 1, Attachment 2, Management __________________ __________________ and Protection of Personal Health Information Policy. Signature of Authorized/Designated Representative Application continues on page 2. Please provide as much information as you can to help us determine your eligibility quickly. FOR OFFICE USE ONLY Community Access Site Participant Name/Phone Number: Date Stamp: CF-ES 2337, PDF 11/2011 [65A-1.205, F.A.C.] 1 HOUSEHOLD INFORMATION: If you need extra space in the following sections, please use extra pages. Please provide as much information as you can to he lp us determine your eligibility quickly. List yourself and all those living in your home even if you are not applying for them. If you are not applying for a member, y ou do not have to give their SSN or citizenship status. If living in a nursing home or other institutional arrangement, list only self, spouse and dependents. OPTIONAL INFORMATION – ETHNICITY: A = Hispanic or Latino ; B = Not Hispanic or Latino RACE: You may choose one or more numbers: 1 – American Indian or Alaskan Native, 2 – Asian, 3 – Black or African American, 4 – Native Hawaiian, 5 – White Section A – List All Adults Living At Your Address Legal Name First, Middle, Last Relationship to you Want to Apply? Sex Social Security Number (see instructions above) Date and Place of Birth U.S. Citizen Ethnicity (see above) Race (see above) Marital Status Attends School/ # Hours/Week/ Last Grade Completed Buys and Eats Food with You SELF YES NO F M YES NO USCIS # A B 1 2 3 4 5 YES NO # hours per week:____________ Last Grade Completed:___________ YES NO YES NO F M YES NO USCIS # A B 1 2 3 4 5 YES NO # hours per week:____________ Last Grade Completed:___________ YES NO YES NO F M YES NO USCIS # A B 1 2 3 4 5 YES NO # hours per week:____________ Last Grade Completed:___________ YES NO YES NO F M YES NO USCIS # A B 1 2 3 4 5 YES NO # hours per week:____________ Last Grade Completed:___________ YES NO Section B – List All Children Living At Your Address. If anyone is pregnant, list “unborn” as the name and the due date as the date of birth. Legal Name First, Middle, Last Relationship to you Want to Apply? Sex Social Security Number (see instructions above) Date and Place of Birth U.S. Citizen Ethnicity (see page 2) Race (see page 2) Child under Age 5 Immunized Attends School/ School Name Date To Graduate Buys and Eats Food with You Child 1 Would you like this child to get child health checkup services? YES NO YES NO F M YES NO USCIS # A B 1 2 3 4 5 YES NO YES NO If yes, school name: YES NO Child 2 Would you like this child to get child health checkup services? YES NO YES NO F M YES NO USCIS # A B 1 2 3 4 5 YES NO YES NO If yes, school name: YES NO CF-ES 2337, PDF 11/2011 2 Section B – List All Children Living At Your Address. If anyone is pregnant, list “unborn” as the name and the due date as the date of birth. Child 3 Would you like this child to get child health checkup services? YES NO YES NO F M YES NO USCIS # A B 1 2 3 4 5 YES NO YES NO If yes, school name: YES NO Child 4 Would you like this child to get child health checkup services? YES NO YES NO F M YES NO USCIS # A B 1 2 3 4 5 YES NO YES NO If yes, school name: YES NO Medicaid: For children under age 16, if no other proof of identity is available such as school records or photo ID, read and s ign below: I certify under penalty of perjury that all the children listed above are who I claim them to be. __________________ ________________________ Signature Section C – Absent Parent Information: Provide the following information for each child in Section B whose mother and/or father is not in the home. Absent Parent’s Name and Last Known Address Date of Birth Social Security No. Race Reason for Absence Mother (see pg.2) Mother’s Place of Birth Mother’s Phone Number Medical Insurance Information Is this the child’s legal parent? YES NO Do you want Child Support Enforcement services if not approved for benefits? YES NO Carrier Policy Name: Number: Child 1 Mother’s Employer’s Name: Employer’s Address: Employer’s Phone #: Absent Parent’s Name and Last Known Address Date of Birth Social Security No. Race Reason for Absence Father (see pg.2) Father’s Place of Birth Father’s Phone Number Medical Insurance Information Is this the child’s legal parent? YES NO Do you want Child Support Enforcement services if not approved for benefits? YES NO Carrier Policy Name: Number: Father’s Employer’s Name: Employer’s Address: Employer’s Phone #: Absent Parent’s Name and Last Known Address Date of Birth Social Security No. Race Reason for Absence Mother (see pg.2) Mother’s Place of Birth Mother’s Phone Number Medical Insurance Information Is this the child’s legal parent? YES NO Do you want Child Support Enforcement services if not approved for benefits? YES NO Carrier Policy Name: Number: Child 2 Mother’s Employer’s Name: Employer’s Address: Employer’s Phone #: Absent Parent’s Name and Last Known Address Date of Birth Social Security No. Race Reason for Absence Father (see pg.2) Father’s Place of Birth Father’s Phone Number Medical Insurance Information Is this the child’s legal parent? YES NO Do you want Child Support Enforcement services if not approved for benefits? YES NO Carrier Policy Name: Number: Father’s Employer’s Name: Employer’s Address: Employer’s Phone #: CF-ES 2337, PDF 11/2011 3 Section C – Absent Parent Information: Provide the following information for each child in Section B whose mother and/or father is not in the home. Absent Parent’s Name and Last Known Address Date of Birth Social Security No. Race Reason for Absence Mother (see pg.2) Mother’s Place of Birth Mother’s Phone Number Medical Insurance Information Is this the child’s legal parent? YES NO Do you want Child Support Enforcement services if not approved for benefits? YES NO Carrier Policy Name: Number: Child 3 Mother’s Employer’s Name: Employer’s Address: Employer’s Phone #: Absent Parent’s Name and Last Known Address Date of Birth Social Security No. Race Reason for Absence Father (see pg.2) Father’s Place of Birth Father’s Phone Number Medical Insurance Information Is this the child’s legal parent? YES NO Do you want Child Support Enforcement services if not approved for benefits? YES NO Carrier Policy Name: Number: Father’s Employer’s Name: Employer’s Address: Employer’s Phone #: Absent Parent’s Name and Last Known Address Date of Birth Social Security No. Race Reason for Absence Mother (see pg.2) Mother’s Place of Birth Mother’s Phone Number Medical Insurance Information Is this the child’s legal parent? YES NO Do you want Child Support Enforcement services if not approved for benefits? YES NO Carrier Policy Name: Number: Child 4 Mother’s Employer’s Name: Employer’s Address: Employer’s Phone #: Absent Parent’s Name and Last Known Address Date of Birth Social Security No. Race Reason for Absence Father (see pg.2) Father’s Place of Birth Father’s Phone Number Medical Insurance Information Is this the child’s legal parent? YES NO Do you want Child Support Enforcement services if not approved for benefits? YES NO Carrier Policy Name: Number: Father’s Employer’s Name: Employer’s Address: Employer’s Phone #: Section D – General Information: Answer the following questions about those listed in Sections A and B who are applying for assistance. 1. Is everyone a resident of the state of Florida? YES NO If no, who is not? 2. Is anyone in the household pregnant? YES NO Who? Due Date: # Babies Due: * 3. Has anyone attended a school conference for any of the children who are ages 6-18? YES NO Who? When? 4. Has anyone or their parent (if still a child) or deceased spouse (if applicable) served in the U.S. military? YES NO Who? When? 5. Is anyone in your household a sponsored noncitizen? YES NO Who? 6. Is anyone living in a special setting such as a homeless shelter, drug treatment center, nursing home, assisted living facility, adult family care home, mental health residential treatment facility, or other institution? YES NO Who? Facility Name and Type: 7. Is anyone a foster child? YES NO Who? * 8. Are any of the children limited or prevented in any way in his or her ability to do the things most children of the same age can do? YES NO Who? * 9. Do any of the children need to get special therapy, such as physical, occupational or speech therapy, or treatment or counseling for an emotional, developmental, or behavioral problem? YES NO Who? * 10. Do any of the children need or use more medical care, mental health, or educational services than is usual for most children of the same age? YES NO Who? 11. If you are applying for nursing home type services, do you have a child (of any age) living in your home who is blind or disabled? YES NO Who? What is their relationship to you? 12. Has anyone been determined disabled by Social Security or the State of Florida? YES NO Who? CF-ES 2337, PDF 11/2011 * Indicates information is optional for the Food Assistance Program 4 Section D – General Information: Answer the following questions about those listed in Sections A and B who are applying for assistance. 13. Is anyone claiming to be disabled who has not already been determined disabled by Social Security or the State of Florida? YES NO Who? 14. Has anyone been denied Supplemental Security Income (SSI) in the past 90 days? YES NO Who? When? * 15. Does anyone in your household need help with Medicare premiums or medical bills from the past three (3) months? YES NO Who? * 16. Does anyone who was denied for disability have a new medical condition not considered by the Social Security Administration? YES NO Who? 17. Is anyone in your household a victim of human trafficking? (Victims of human trafficking are people taken, kept, or moved by force or fraud for sexual exploitation or forced labor.) YES NO Who? If you need extra space in the following sections, please use extra pages. Section E – Assets & Insurance: Answer the following questions about those listed in Sections A and B who are applying for assistance. 1. Does anyone that you are applying for own all or part of any assets, such as: vehicles, bank accounts, tax sheltered accounts, property, Certificates of Deposit (CDs), cash, mortgage notes, promissory notes, *loans , *IRAs , *401Ks , bonds, annuities, stocks, real estate, life estate, trusts, *Keogh plans , *continuing care retirement community or life care community contracts , burial contracts/plots, prepaid funeral expenses, savings bonds or certificates, business assets, large sums of money received in last 3 months, health/long-term care/life/auto insurance, HMO s, Medicare or Medicare supplements, etc? Include the assets/insurance of parents of minor child applicants if living in the home and assets/insurance of spouses of applicants if living in the home. YES NO If yes, list below: IMPORTANT INFORMATION FOR OWNERS OF AN ANNUITY: In accordance with Public Law 109-171, individuals (and their spouses) who are applying for or receiving Medicaid Institution al Care Program (nursing home care), Hospice, Home and Community Based Services waiver programs, or the Program of All-Inclusive Care for the Elderly must list all annuities they own. Certain annuity purchases (or other transactions) made on or after 11/01/2007 will be considered a transfer of an asset for less than fair market value unless the annuity names the State of Florida, Agency for Health Care Administration, as the first remainder beneficiary (or second remainder beneficiary after the community spouse or minor or disabled child) for the total amount of Medicaid funds paid on the Medicaid recipient’s behalf. Individual Type of Asset or Insurance Vehicles Year, Make, Model Amount Owed on Vehicle/Property Location of Asset/Insurance Bank/Company Name and Address Account # or Insurance ID # Amount or Value 2. Are any of the above assets set aside to cover burial expenses? YES NO Which? What Amount? 3. Has anyone closed bank accounts or other investments, added anyone to the title of an asset, given away assets or property, or liquidated assets greater than $3,000 to buy another asset or service in the last 5 years? YES NO Who? What? When? Value? Section F – Income: Answer the following questions about those listed in Sections A and B who are applying for assistance. 1. Does anyone that you are applying for receive any type of income, such as: wages, tips, self-employment, Social Security/Ra ilroad Retirement or Disability, SSI, other disability, VA income, pension, Civil Service, unemployment, child support, alimony, dividends, interest, stipend, money from another person, annuity, rent, workers’ compensation, estate/trust, public assistance, grants, scholarships, student loans, reparations payments, training allowances, etc? (Include the income of parents living at home with minor child applicants and income of sp ouses and dependents of applicants if living in the home.) YES NO If yes, list below: Individual Type of Income Name of Employer or Source of Income Phone Number of Employer Monthly Amount Before Deductions How Often Received (weekly/biweekly/monthly) Pay Day on What Day of the Week Weekly # of Work Hours 2. Has anyone’s income in the household ended in the last 60 days? YES NO Who? When? Source? CF-ES 2337, PDF 11/2011 * Indicates information is optional for the Food Assistance Program 5 Section F – Income: Answer the following questions about those listed in Sections A and B who are applying for assistance. 3. Will anyone in your household receive additional income from the source that ended? YES NO Who? When? Gross amount (before deductions) received in this month only? $ 4. Does anyone have a pending application for Social Security or Unemployment Compensation benefits? YES NO Who? Which Benefit? 5. Have deposits been made to Income or Miller Type Trusts in any of the past 3 months? YES NO Whose Trust? Date(s) and Amount(s) of Deposit(s): Section G – Expenses: Answer the following questions about those listed in Sections A and B who are applying for assistance. 1. Is anyone that you are applying for required to pay expenses, such as: rent, mortgage, property tax, homeowner’s insurance, condo/maintenance fees, gas, electric, fuel, LIHEAP, medica l bills such as but not limited to: prescriptions, glasses, transportation, doctor visits, dental, health aides, hospitalization, or insurance or Medicare premiums not covered by insurance or another third party, telephone, day (child) care, or court ordered child support for a child not in your household? Include the expenses of parents of minor child applicants if living in the home and expenses of spouse of applicants if the spouse is living at home. YES NO If yes, list below: Type of Expense Who is Obligated to Pay This Expense If a Medical Expense, Who Received the Medical Service? Monthly Amount Paid to Whom Date Paid Still Owed? For Court Ordered Child Support Only, Name of Child for Whom Support is Paid YES NO YES NO YES NO YES NO 2. How do you heat or cool your home? 3. Does anyone help you pay expenses? YES NO If yes, explain: YOU CAN APPLY TO REGISTER TO VOTE HERE If you are not registered to vote where you live now, would you like to register to vote here t oday? Check YES if you would li ke to apply to regist er to vote or update your voter registration information. If you check the NO box or do not check a box, yo u will be considered to have decided not to apply to register to vote or update your voter regi stration information. Checking YES, NO, or leaving this question blank will not affect your receipt of benefits. YES NO NOTICE OF RIGHTS Help: If you would like help in filling out your voter registration a pplication, we will help you. The decision whether to seek or accept help is yours. You ma y fill out the voter registration application in private. Benefits: If you are applying for public assistance from this agency, applying to register, or declining to register to vote will not a ffect the amount of assistance you will be provided by this agency. Privacy: Your decision not to register or update your record and the lo cation where you applied to register or update your voter regis tration record is confidential and may only be used for voter registration purposes. Formal Complaint: If you believe someone has interfered with either your right to apply to register or to decline to register to vote, your rig ht to privacy in deciding whether to apply to register to vote, or your right to choose your own political pa rty or other political preference, you may file a complaint with : Florida Secretary of State, Division of Elections, NVRA Administrator, R.A. Gray Building, 500 S. Bronough Street, Talla hassee, Florida 32399-0250. Forms for filing a complaint are a vailable at http://ele ction.dos.state.fl.us/n vra/index.shtml or call 1-850-245-6200. [Authority: National Voter Registration Act (42 U.S.C. 1973 gg); ss. 97.023, 97.058 and 97.0585, F.S.] YOU MAY BE ELIGIBLE FOR REDUCED TELEPHONE RATES Check YES if you would like DCF to release your Name, SSN, Phone Number, and the fact that you receive food assistance, Temporary Cash Assistance, or Medicaid to the local telephone company so you may receive a reduced telephone rate through the Lifeline Program. YES NO CF-ES 2337, PDF 11/2011 6 NOTICE OF PENALTIES You may be subject to prosecution for knowingly providing in correct information to receive public assistance benefits. REPORTING REQUIREMENTS You must report any change in your situation according to program requirements to DCF. Food assistance households are required to report changes that increase benefits and food assistance households with a member disqualified for breaking progr am rules, felony drug trafficking, running away from a felon y warrant, or not participating in a work program must report when the household’s monthly income exceeds the food assi stance gross income limit for the household size. Households r eceiving Medicaid or Temporary Cash Assistance must continue to report changes that c ould affect eligibility within 10 days. IMPORTANT INFORMATION FOR IMMIGRANTS Applying for or receiving food assistance benef its or Medicaid will not affect you or y our family members’ immigration status o r ability to get permanent resi dent status (green card). Receiving Temporary Cash Assistance or long–t erm institutional care such as nursing home benefits might create problems with getting that status, especially if the benefits are your family’s only income. NOTICE OF PENALTIES – Food Assistance: If you are found guilty (by a state or federal court, or an admin istrative disqualification heari ng, or sign a hearing waiver) of intentionally making a false or misleading statement, concealing or withholding facts in order to receive or in an attempt to receive food assistance or committing any act that violates the Food and Nutrition Act, food assistance regulations, or any state statute for purpos es of using, presenting, tran sferring, acquiring, receiving, or possessing food assistance benef its, you will be disqualified. You will be ineligible for food assistance for 12 months for the first violation, 24 months for the second violation and permanent ly for the third violation. If you are convicted of trafficking in food assistance benefits of $500 or more, you will be disqualified permanently. If you are convicted of these acts, depending on the severity, you may be fined up to $250,000, imprisoned for up to 20 years, or both. If you are convicted by a state or federal court of making a fraudulent statement with respect to identity or residency in orde r to receive food assistance in more than one state at the same time, you will be ineligible to participate in the Food Assistance Program for a period of 10 years. If you are fleeing to avoid prosecution, custody, or confinemen t, after conviction for a crime or an attempt to commit a crime, which is a felony, or are in violation of probation or parole imposed under a federal or state law, you are ineligible for f ood assistance. This information may be disclosed to other feder al and state agencies for official examination, and to law enforcement officials for the purpose of appr ehending persons fleeing to avoid the law. If you are found guilty of a drug-trafficking felony, or convicted by a federal, state, or local court of trading firearms, ammunition, or explosives for food assistance benefits, you are ineligible for food assistance. NOTICE OF PENALTIES – Temporary Cash Assistance: If you intentionally give false information or hide information to receive or continue to receive Temporary Cash Assistance and are convicted by a state or federal court or by an administrative disqualification hear ing, or sign a hearing waiver, you may be di squalified for 12 months for the first violatio n, 24 months for the second vi olation and permanently for the third violation. If you are found guilty of a drug-trafficking felony, or fleeing to avoid prosecution, custody or confinement, after conviction for a crime or an attempt to commit a crime which is a felony, or are in violation of probation or parole imposed under a federal or state law, you are ineligible for Temporary Cash Assistance. If you are convicted by a stat e or federal court of making a fraudulent statement with respect to identity or residency in order to receive Temporary Cash Assistance in more than one state at the same time, you will be ineligible to participate in the Temporary Cash Assistance pr ogram for a period of 10 years. FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES NON-DISCRIMINATION STATEMENT No person shall, on the basis of race, color, religion, national origin, sex, age, or disability be excluded from participation in, be denied the benefits of, or be subjected to unlawful discrimination under any program or activity receiving or benef iting from federal financial assistance and administered by the Department. To file a complaint, alleging violations of this policy, contact the Office of Civ il Rights, Florida Department of Children and Families, 1317 Winewood Boulevar d, Tallahassee, Florida 32399-0700 or call 1-850-487-1901, or TDD 1-850-922-9220. USDA-HHS NON-DISCRIMINATION STATEMENT In accordance with Federal Law and U. S. Department of Agricultur e (USDA) and U. S. Department of Health and Human Services (HH S) policy, this institution is prohibited from discriminating on the basis of race, color, national origin, sex, age, or disability. Under the Food Stamp Act and USDA policy , discrimination is prohibited also on the basis of religion or political beliefs. To file a complaint of discrimination, contact USDA or HHS. Wr ite USDA, Director, Office of Adjudication, 1400 Independence Avenue, S. W., Washington, D. C. 20250- 9410 or call toll free (866) 632-9992 (voice). Individuals wh o are hearing impaired or have speech disabilities may contact US DA through the Federal Relay Service at (800) 877-8339; or (800) 845-6136 (Spanish). Write HHS, Director, Office for Civil Rights, Room 506-F, 200 Independ ence Avenue, S.W., Washingt on, D.C. 20201or call (202) 619-0403 (voice) or (202) 619-3257 (TTY). USDA and HHS are equal opportunity providers and employers. SUBMITTING THE APPLICATION FOR ASSISTANCE An Application for Assistance may be submitted to any Department of Children and Families Economic Self-Sufficiency Services of fice in the State of Florida by you, or by someone acting for you, in person, by mail, by facsimile (FAX), or el ectronically through the internet. Applications received during n ormal business hours are considered received the same day. When an application is received after normal business hours, it will be considered received on the first business day following its receipt. CF-ES 2337, PDF 11/2011 7


Form NameFlorida Food Stamp Application Form
Form TypeFood Stamp Application
Issuing AuthorityFlorida Department of Children and Families or relevant state agency
PurposeTo apply for food assistance through the Supplemental Nutrition Assistance Program (SNAP) in Florida
Form VersionLatest available version
FormatTypically available as a downloadable PDF form
AvailabilityOfficial government website of the Florida Department of Children and Families or local Department of Children and Families offices
Form NumberVaries by form version
File SizeVaries depending on the specific form and its components
RequirementsAdobe Acrobat Reader or compatible PDF reader
Accessible DevicesComputers, smartphones, tablets, and other devices with PDF reader apps
Filling Out MethodPrintable (Handwritten) or Online (Web-based, if available)
SubmissionSubmission through mail, fax, in person at local Department of Children and Families offices, or online (if available)
FeesNo application fee
Supporting DocumentsSupporting documentation may include proof of identity, income, and household information
Official WebsiteFlorida Department of Children and Families - SNAP
Food Stamp Pdf

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