1. SNAP Food Stamp Self Help Tools and Instruction
Shannon Madigan, Property Manager

2. Massachusetts Department of Transitional Assistance
SNAP (formerly Food Stamps) BENEFITS

3. AGENDA What is SNAP? Application Process Required Documentation
Proof of Certain Expenses
SNAP Benefits Application - Step by Step instructions
Determining the Monthly Rent Amount
Other Agency Certification of Shelter Expenses for Licensed Group Home Residents form
Request for Authorized Representative form
Final Instructions for New Applications
Annual Recertifications

4. What is SNAP?
SNAP is the Supplemental Nutrition Assistance Program. This was formerly known as Food Stamps.
Who offers SNAP?
The Massachusetts Department of Transitional Assistance (DTA)
Who should apply for SNAP?
All residents in ServiceNet’s Hour Residential Programs

5. APPLICATION PROCESS Create a food stamp folder for each resident.
Make sure you have all the required documentation including proof of:
Identity
Massachusetts residency
Income *
Assets*
Any out of pocket medical expenses.
Fill out the application with each resident’s individual information.
Be sure the resident has signed all designated areas.
Attach required paperwork (photo I.D., proof of income and assets, etc.)
Make a copy for the resident’s file.
DO NOT MAIL THE ORIGINAL TO DTA!! Give it to Shannon for review. She will send it to DTA.
*Note: Rep payee sheets cannot be used to identify income and asset information. DTA will need the actual income/asset paperwork from Social Security, the resident’s employer, and the resident’s bank.

6. REQUIRED DOCUMENTATION
Proof of Identity: Driver’s license, birth certificate or other proof of identity.
Proof of Massachusetts Residency: Mortgage, tax, homeowner’s insurance or utility bills, rent receipt or lease. If homeless, a collateral contact, motor vehicle registration, statement from a shelter or a statement from the person he or she is staying with.
Earned Income: Pay stubs or written statement from employer on letterhead showing income before taxes for the past four weeks.
Other Income: Most recent copy of Social Security check or copy of award letter, proof of unemployment compensation, workers’ compensation, pension, child support or alimony.
Self-Employment: Most recent federal tax return (Schedule C) or last three months of business records.
Non-Citizen Status: For any non-US citizen, alien registration card or other immigration document.
Rental Income: If the resident gets paid by someone who rents a room or apartment, provide a copy of the lease agreement or statement from the tenant showing the amount of rent paid.
Child Support Payments: If the resident makes child support payments to someone living elsewhere, show proof of the legal obligation to make the payment, such as a court order, tax returns showing legally obligated support payments, verification of withholding from unemployment compensation, and the amount paid.

7. PROOF OF CERTAIN EXPENSES
SNAP rules allow applicants to deduct certain expenses from income.
Proof of any of the following expenses may result in higher SNAP benefits.
Housing Costs: Not needed as part of initial submission. If later requested by DTA, refer the caller to Shannon.
Utilities: Not needed as part of initial submission. If later requested by DTA, refer the caller to Shannon.
Medical Expenses: If the resident is age 60 or older or has a certified disability, the amount of out-of-pocket medical expenses can be shown by receipts for co-payments or premiums on health insurance, dentures, eyeglasses, hearing aid batteries, prescription medications, doctor-prescribed pain relievers, over-the-counter drugs, and transportation to get to medical services.
Child Care or Adult Dependent Care Expenses: The amount paid for dependent care expenses can be shown by a written statement from the dependent care provider, or a canceled check or money order paid to the dependent care provider.

8. SNAP Benefits Application
Massachusetts Department of Transitional Assistance
SNAP Benefits Application
(formerly Food Stamps)
Source: (please check one)
r CEO r Project Bread r DMH r DMR r BMC r Food Pantry r MRC r Other _______________
Is your site funded by DMH or DDS (DMR)?
Check the appropriate box to the right!
1. Information About You (Answer all boxes.) If you are a noncitizen who chooses NOT to apply for SNAP benefits, you do not need to tell us your Social Security number or immigration status.
Last Name First Name Middle Initial
 Fill these sections out with the resident’s information
Social Security Number
Is this name your (check one) r Name at Birth r Maiden Name r Married Name r Prior Marriage Name r Alias
Date of Birth
Gender r M r F
Are you pregnant? r yes r no
Marital Status (check one) r Married  r Never Married r Divorced r Separated r Widowed
What is your preferred language?
Your ethnicity/race: This information is collected to make sure everyone is treated fairly. Your answer is voluntary, and it will not affect your eligibility or benefit amount.
Ethnicity: Hispanic or Latino r yes r no
Race: (check all applicable)
r American Indian or Alaska Native r Asian r Black or African American
r Native Hawaiian or Other Pacific Islander r White
Do you have a special situation? (Check all boxes that apply to you.)
Physical/Mental Impairment r Hearing Impaired r Visually Impaired
r Interpreter Required r Sign Language Required r Other____________________
Check “Physical/Mental Impairment” and any other special situations that apply

9. SNAP Benefits Application – Page 1 (continued)
2. Information About Where You Live (Answer all boxes.)
Your current address
Number and Street
Enter the address of the program.
Apt #
City, State, ZIP
Are you homeless? r yes no
Is your current address temporary? r yes no
Is your current address your mailing address? r yes no
If a temporary address, list your permanent address.
If you have a different mailing address, please list.
  King Street Northampton, Ma Attn: Shannon Madigan
Your daytime telephone number(s) Use the residence’s phone number or the staff person’s cell phone number. 
( ________ ) _________-_______________ ( 413 ) Use Authorized Rep-payee #
A good time of day to reach you by telephone: Time: ________________
Circle all that apply: Monday Tuesday Wednesday Thursday Friday
Type of housing you live in
Private Housing Public Housing  Commercial Boarding House
 Transitional Housing    Residential Facility    Employer-provided Housing     
 Teen Living Program  Migrant Campsite  Shelter 
3. Person Helping with Your Application
Last Name
Put in the staff member’s
First Name Middle Initial
name and the program address and phone
Telephone Number
number in this section.
Number and Street City/Town State ZIP
4. Authorized Representative
 Do you want to give this person permission to apply or get SNAP benefits for you? yes r no

10. SNAP Benefits Application – Page 2
5. Waiver of the Face-to-Face Interview
 If you are unable to come to the DTA office for an interview, please check all reasons that apply.
Elderly/Disabled Transportation Problems r Work during DTA office hours
r Child Care/Care of Disabled Household Member r Other __________________
IMPORTANT: Be sure to list your telephone number(s) on page 1. We need to be able to call you if we have questions about your application or have to interview you over the phone.
6. Questions Regarding Citizenship Status
 a. Are you and all household members U.S. citizens by birth or naturalization? r yes r no
Answer ONLY for the applicant, not other residents.
If you check “Yes” go to #8. If you check “No” also check the box in 6.b.2 and then go to #8. b.
2. Check here if all members choose to apply:   Check this box if the answer to 6a was “no,” otherwise go to #8.
Information About People You Live With - Please list everyone you live with. Do not include yourself.
Do not answer Question #7. Each resident pays a rent for his or her own room/unit. It is not considered a family household.
Is there a child(ren) under age 18 living with you who is not your child, and who is not under your supervision and control?
If yes, who? ____________ r yes no
Is anyone living with you a roomer or boarder (person who pays for a room or room and meals)? r yes no If yes, what is this person’s name? __________________________________
Are foster care payments being made to your household for anyone living with you? r yes no
If yes, for whom are the payments being made? ________________________
11. Are you or is anyone living with you a resident of a state other than Massachusetts or country other than the U.S.
or are you or is anyone living with you intending to leave Massachusetts? r yes no
If yes, who is not a resident or is intending to leave? ___________________________
 12. Are you or is anyone living with you NOT a U.S. citizen? Answer for the applicant only. r yes rno

11. SNAP Benefits Application – Page 3
13. Do you or anyone living with you who is 18 or older and a United States citizen and Massachusetts
resident want to register to vote?   Answer for the applicant only.  yes  no
If yes, who would like to register? _____________________________
Are you or is anyone living with you physically or mentally disabled temporarily or long-term?  yes  no
If yes, who is disabled? _____SELF_____
15. Earnings
 Answer this question for the applicant ONLY, not the other residents.
Are you or is anyone living with you presently working, or were you or anyone else living with you working in the last 60 days?  yes  no
If yes, complete the following section. (Attach a separate sheet, if necessary.)
IMPORTANT: Be sure to complete this section if you or anyone else living with you is self-employed.
Last Name First Name
Employer Name, Address & Telephone Number
Job Title
Start Date
End Date
Hourly Wage
$ ________
Weekly Hours
Weekly Tips
$ _______
How Often Paid?
Permanent Job?
 yes  no
If job ended, last day of work ______/_____/_______
Record most recent wage information here:
Date
From To
Gross Amount
Hours $

12. SNAP Benefits Application – Page 3 (continued)
Answer the following questions for the applicant ONLY, not for any other residents.
DON’T FORGET TO ATTACH THE REQUIRED DOCUMENTATION!!
16. Other Income
 Are you or is anyone living with you eligible to receive or receiving any other type of income such as Unemployment Compensation, Child Support, Social Security, SSI, Workers’ Compensation, Veterans’ Benefits, Pensions or Rental Income?  yes  no
If yes, complete the following section. (Attach a separate sheet, if necessary.)
Name
Type of Income
Amount
How often received?
Date Income Started
Do you or does anyone living with you have a court order (legal obligation) to pay child support to a child not living with you?   yes  no
How often paid?  Monthly  Weekly Amount $ ___________________
18. Do you or does anyone living with you have child care or adult dependent care expenses?       yes  no
19. Do you or does anyone living with you who is 60 years old or older or who is disabled have health insurance expenses?    yes  no
    How often paid?  Monthly  Weekly Amount $ ___________________
20. Do you or does anyone living with you who is 60 years old or older or who is disabled have out-of-pocket medical expenses?    yes  no If yes, complete the following section.
Name
Type
How often paid?
Amount
Date you started paying
21. Shelter Expenses
What type of shelter expenses do you have?
Rent/Mortgage  yes  no Rent/Mortgage amount per month $ ___**___
Property Taxes  yes  no **See the page Determining the Monthly
Other  yes  no Rent Amount before filling in this number

13. SNAP Benefits Application – Page 4
22. Utility Expenses
What type of utility expenses do you pay for separate from your rent?
Heating (gas, oil or electric) and/or air conditioning costs  yes r no
Any other utilities (not including heating/air conditioning) yes r no
A telephone only, including cellular phone r yes r no
Have you received or do you think you will receive Fuel Assistance benefits? r yes no
Because our residents pay rent and a fee the answer to the heating and utility questions will always be “Yes.” A portion of all residential fees go towards the utilities in each residential house. These answers are accurate and will provide the resident with greater benefits.
Be sure to also answer yes to the telephone question.

14. DETERMINING THE MONTHLY RENT AMOUNT
If ANY RESIDENT in your site has a SUBSIDY, the maximum rent for all residents of that site is determined by the local Housing Authority, not ServiceNet.
If the applicant HAS a subsidy, use the Housing Authority’s Tenant Payment (sometimes called Tenant Share) as the rent amount.
If the applicant DOES NOT have a subsidy, use the LOWER of the following two numbers:
The amount determined by the standard calculation based on the applicant’s income, or
The Housing Authority’s Total Rent (sometimes called Contract Rent).
If NO ONE in your site has a subsidy and it is a DBIS residence, use the LOWER of the following two numbers:
$ per month.
If NO ONE in your site has a subsidy and it is an MHRS residence, determine the applicant’s rent using the 35% rule.
If you have any questions concerning rent calculation, please call Shannon at
A sample Housing Authority letter is on the next page.

18. FINAL INSTRUCTIONS FOR NEW APPLICATIONS
All forms must be signed by the resident. ( a scribble, mark, dot, however they can sign is acceptable)
All required attachments must be compiled.
Make a copy for the program file and send the original and all the attachments to Shannon. Shannon will review the application and submit it DTA. DO NOT MAIL OR FAX THE APPLICATION TO DTA.
If the resident refuses to sign any or all of the forms, attach a letter signed by you on ServiceNet letterhead stating that the applicant refuses to sign the form.
ServiceNet should begin receiving the benefits within 7-10 days if all the applicable information is provided and verified by DTA. IF THE APPLICATION IS INCOMPLETE THIS WILL NOT BE THE CASE.
If you have any questions, call Shannon at

19. ANNUAL RECERTIFICATIONS
All food stamp recipients must be recertified every 2 years. Whenever you receive a recertification application from DTA it is important that it be completed, signed and returned within 10 days.
The application form will be mostly prepopulated based on information submitted previously.
Upon receipt of the recertification the rep-payee will:
Contact staff to verify the information on the form
Make any necessary changes
Sign the form as the authorized rep-payee
Request and attach any documentation required if changes are made
Make a copy for file
Fax or deliver the original form directly to DTA (see the next page for the correct address and fax number!).
Once the DTA sends the food stamp benefit amount letter, the authorized rep-payee will put a copy letter of the amount in staff mailbox and update the food stamp tracking sheet.

20. Thank you!