For all Food Stamp (SNAP), TANF, and Medicaid Applicants
Note: The person applying for benifits must sign the application for it to be valid. If you have designated an authorized representative on the application, they should also sign. If the represenative does not sign, this will not prevent your application from being processed, but they may not be included as your representative.
When you sign, you are promising:
- You and/or the people for whom you are applying are U.S. citizens or lawfully present non-citizens
- All information provided on the application is true and correct to the best of your knowledge
- You understand and agree that DFCS, DCH (the Department of Community Health), and all authorized Federal agencies have the right to verify the information you’ve provided
- Information may be obtained from past and present employers
- Your information is used to track wage information and participation in work actives for the SNAP work program
- You will report changes in your situation according to SNAP and TANF program rules.
- You will report if anyone receive lottery or gambling winnings that equal $4250 or more before taxes or other amounts are garnished
- You undersand if you knowingly lied about your information, your benefits can be reduced or denied and you can be possibly prosecuited or disqualified from programs.
- You understand you can be prosecuted if you give false information or hide information.
- You understand if you do not tell your caseworker about some of your expenses or you fail to verify some of you expenses during your application or renewal, your caseworker may not use those expense to calculate your Food Stamp benefits.
- You undersand that DHS (the Depatment of Human Services) collects your personal information such as names, addresses, phone numbers, email addresses, dates of birth, etc
- When you submit your personal information, you undersand the agency may collect, use, and disclose that information according to DHS policies and procedures and as permitted or required by law and regulations.
- What does this mean? It means the agency may share your information with other governement agencies including child support, Social Security, child protective services or the court system if you are being prosecuted for DFCS related violations.
- What it does not mean: DFCS can’t just give your information to anyone who shows up and asks for it. DFCS cannot give your information to the police. Your neighbors, friends, enemies, and the newspaper cannot ask for your information. You still have a right to privacy.
