The Mississippi SNAP (Supplemental Nutrition Assistance Program) Application form, identified as MDHS-EA-900, serves as a critical starting point for residents seeking nutritional assistance. Structured to collect essential information, it determines eligibility for both SNAP itself and, if applicable, Temporary Assistance for Needy Families (TANF). Applicants must provide detailed personal and financial information, undergo an interview—potentially over the phone due to hardship circumstances—and meet specific eligibility criteria outlined within the document. This form underscores the commitment to support individuals and families in accessing vital food resources.
The Mississippi Supplemental Nutrition Assistance Program (SNAP) application form, officially named the MDHS-EA-900 and last revised on August 1, 2013, serves as a crucial gateway for eligible individuals and families seeking nutritional assistance within the state. This comprehensive document, used exclusively for office processing, initiates the assessment process by collecting essential information such as the applicant's name, social security number, date of birth, and residence details. It inquires about preferences for receiving notifications and specifies the type of benefits sought, distinguishing between Temporary Assistance for Needy Families (TANF) and SNAP. Importantly, the form establishes the necessity of an interview—potentially waivable for a telephonic one under certain hardships—to determine eligibility. It requests details regarding household income, expenses, and assets, and it highlights the urgency of immediate filing for SNAP benefits to leverage potential eligibility from the day of submission. Furthermore, it emphasizes the significance of accurately disclosing citizenship status and complying with work-related requirements for SNAP eligibility. Penalties for fraudulent information are clearly outlined, underscoring the program's commitment to integrity. The document also serves a dual purpose of collecting demographic data intended to evaluate the program's effectiveness without impacting eligibility determination. This form not only navigates applicants through the procedural aspects of applying for assistance but also underscores the stringent measures in place to ensure aid reaches those genuinely in need, reflecting both federal and state efforts to combat hunger while maintaining program integrity.
MISSISSIPPI
MDHS-EA-900
Revised 02-01-17
Page 1
FOR OFFICE USE ONLY:
DATE
CASE NUMBER:_________________________________RECEIVED:________________
Appointment Date:_______________ Time:___________ 303B: ❑ Initials:____________
InterviewedTelephonic
By:_______________________________ Interview:__________________ 530: ❑Initials:
TEMPORARY ASSISTANCE FOR NEEDY FAMILIES (TANF) APPLICATION
SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP) APPLICATION
Name___________________________________SSN_______________________________Date of Birth______________________
Residence Address_______________________________________________________________ Phone______________________
City
State
Zip
Mailing Address__________________________________________________________________ 2nd Phone____________________
Would you like to receive notices by email? ❑Yes ❑No
If yes, email address:_________________________________________
What benefits are you applying to receive?
❑TANF
❑SNAP
Before we can determine your eligibility, you must be
interviewed. Due to household hardship, a face-to-face interview may be waived in favor of a telephone interview on a case-by-case basis. You may file a joint application for both SNAP and TANF or may file a separate application for both programs.
TANF
To begin your application, complete the above section and sign below. We are required to take action within 30 days from the day you give us this form.
SNAP
You may file your application immediately by submitting the forms to the local county office either in person, through an authorized representative, by fax, or by mail as long as we have your name, address and the signature of a responsible household member or your authorized representative. The application filing date is considered the day we receive this form in our office, and benefits are provided from that day, if determined eligible. However, when a resident of an institution jointly applies for SSI and SNAP prior to leaving the institution, the application filing date must be considered the day of your release from the institution. We are required to verify information you provide and take action within 30 days from the date your application is received, unless you are entitled to receive benefits within 7 days. YOU MAY GET SNAP WITHIN 7 DAYS if your household’s gross monthly income is less than $150 and your household’s resources such as cash, checking or savings accounts are $100 or less; or if your rent/mortgage and utilities are more than your household’s co mbined gross monthly income and liquid resources; or if you are a migrant or seasonal farm worker household; and you verify your identity. All SNAP applications, regardless of whether they are joint applications or separate applications, will be processed according to SNAP regulations and timeframes and will not be affected if TANF is denied.
For information regarding services provided by Families First for Mississippi, contact 1-800-590-0818 or visit our website at www.mdhs.ms.gov.
By signing and dating this application, I am giving consent for the attendance records of the children identified on this application to be disclosed by the Mississippi Department of Education to the Mississippi Department of Human Services for use by the Department of Human Services to determine compliance with school attendance requirements of the Temporary Assistance for Needy Families (TANF) Program.
Only US citizens and qualified aliens are eligible for SNAP benefits. Any non-citizens or non-qualified aliens may be left off your application for assistance. Such persons will not be reported to the Immigration and Customs Enforcement agency. Non-citizens included in your application will have eligibility determined under SNAP rules. The income and resources of all persons in your household will be considered in determining eligibility for persons included in the SNAP application.
I certify that each applicant included in my household is a U.S. citizen or alien in lawful immigration status and that the information provided is true to the best of my knowledge. I give permission for the Department of Human Services to make a full review of my case and any necessary contacts to verify my statements. I give consent for the release of income verification to MDHS for all household members that are 18 or above. I know that if I give false or incorrect information, I could be penalized, my case may be denied, and I may be subject to criminal prosecution. I certify that I received the Rights and Responsibilities handout from this agency.
Signature of Applicant
Date
Signature of witness if signed by mark
Signature of Authorized Representative or
Second Parent in TANF
SNAP Outreach
Agency Code
____________
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1.
Has anyone in your household received any income (money, checks, gifts, etc.) this month? ❑Yes ❑No. If yes, how much? $_______
2.
Does anyone expect to receive income later this month? ❑Yes ❑No. If yes, how much? $_________
3.
How much money does your household have in cash, checking account and savings account? $_______________
4
Give the actual expense amounts: Rent/Mortgage $________Electricity $________Gas $_______Water $_______Phone $________
5.
Is your household’s only income from migrant or seasonal farm work? ❑Yes ❑No
6.
Does any household member age 60 or above or disabled have any out of pocket medical expenses that exceed $35? ❑Yes ❑No
7.
Is anyone in your household currently serving a SNAP disqualification due to fraud? ❑Yes ❑No
8.
Have you or any member of your household been convicted of trading SNAP benefits for drugs after 08/22/96? ❑Yes ❑No
9.
Have you or any member of your household been convicted of a drug-related felony that was committed since 08/22/96? ❑Yes ❑No
10. Have you or any member of your household been convicted of buying or selling SNAP benefits over $500 after 08/22/96? ❑Yes ❑No
11.Have you or any member of your household been convicted of fraudulently receiving duplicate SNAP benefits in any State after 08/22/96? ❑Yes ❑No
12.Have you or any member of your household been convicted of trading SNAP benefits for guns, ammunitions, or explosives after 08/22/96? ❑Yes ❑No
13.Are you or any member of your household hiding or running from the law to avoid prosecution, being taken into custody, or going to
jail, for a felony crime or attempted felony crime, or violating a condition or parole or probation? ❑Yes ❑No
14. Are you or any member of your household a resident of a commercial boarding home (establishment that offers meals and lodging for
compensation with the intent of making a profit)? ❑Yes
❑No
15. Are you or any member of your household on strike? ❑Yes ❑No
List who you are applying for beginning with the Head of Household
Name (First, Last)
RELATIONSHIP
SOCIAL SECURITY
AGE
SEX
**OPTIONAL
US
NUMBER
of
CITIZEN
*SEE DISCUSSION
BIRTH
HISPANIC
RACE
Y or N
BELOW
(***Choose
one or more)
4.
**Information pertaining to Ethnicity and Race is not required and will not be used in determining your eligibility or benefit level. This information will be used to help
determine how effective the program is in reaching the eligible population.
***Race Codes: AL-American Indian/Alaska Native; AS-Asian; BL-Black or African American;
HP-Hawaiian or Other Pacific Islander; WH-White
List anyone in your household who you are not including in this application
Relationship to Head of Household
Age
SNAP Authorized Representative
You may appoint someone outside your household to act for your household to make an application and to be interviewed. This person should know your household’s situation well enough to give any information needed to determine your eligibility for SNAP. You are responsible for the information that anyone acting as your authorized representative gives, including any information that may be incorrect.
I would like to appoint: 1. Name
2. Name
As part of the eligibility process for SNAP, I understand that certain household members including myself will be eligible to receive SNAP benefits only by following requirements to register for work, seek employment, and/or accept suitable employment, unless a work exemption is met by that household member. I understand that job seeking services are available through the MS Department of Employment Security, and that I may be required to complete job seeking requirements at a later date. I will accept an offer of suitable employment whether it was received through my own effort or through an employment and training referral. I understand that failure to comply with work registration
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requirements may result in disqualification of a household member or the entire household from SNAP, and that I will explain these work requirements to my household.
I understand that the information included on this application may be disclosed to other Federal and State agencies for official examination, and to law enforcement officials for the purpose of apprehending persons fleeing to avoid the law.
I understand that if a SNAP/TANF claim arises against my household, the information on this application, including all SSNs, may be referred to Federal and State agencies, as well as private claims collections agencies, for claims collection.
PENALTY WARNING: *A Social Security Number (SSN) must be provided or applied for each person for whom assistance is requested per the Food and Nutrition Act of 2008. SSNs will be verified and used for Federal and State data matches, including but not limited to, Social Security, Internal Revenue Service, VA, MS Department of Employment Security, resource/income verifications, program disqualifications, and for collection of fraud debts. State and federal laws provide for fines, imprisonment or both for any person guilty of obtaining assistance to which he/she is not entitled by willfully withholding or giving false information. Information may be verified through collateral contacts when discrepancies are found. Alien status of persons requesting benefits is subject to verification with United States Citizenship and Immigration Services (USCIS) and will require submission of certain information from this application to USCIS.
SNAP PENALTY WARNING: If your household receives SNAP, it must follow the rules listed below. Any member of your household who breaks any of these rules on purpose can be barred from SNAP for 1 year for first offense, 2 years for second offense, and permanently for third offense; fined up to $250,000, imprisoned up to 20 years or both; and subject to prosecution under other federal laws.
DO NOT give false information, or hide information to get or continue to get SNAP benefits. DO NOT trade or sell EBT cards. DO NOT alter EBT cards to get SNAP benefits you are not entitled to receive. DO NOT use SNAP benefits to buy ineligible items such as alcohol and tobacco or to pay food credit accounts. DO NOT use someone else’s SNAP benefits or EBT card for your household.
Individuals determined by a court to have committed the following program violations will be subject to the following penalties:
-If you are found to have used or received benefits in a transaction involving the sale of a controlled substance, you will be ineligible to receive SNAP benefits for a period of two years for the first offense and permanently upon the second such offense.
-If you are found to have used or received benefits in a transaction involving the sale of firearms, ammunition or explosives, you will be permanently ineligible to receive SNAP benefits upon the first occasion of such violation.
-If you have been found guilty of having trafficked benefits for an aggregate amount of $500 or more, you will be permanently ineligible to receive SNAP benefits upon the first occasion of such violation.
-If you have been found to have made a fraudulent statement or representation with respect to your identity or place of residence in order to receive multiple SNAP benefits simultaneously, you will be ineligible to participate in the Program for a period of 10 years.
In accordance with the U.S. Department of Agriculture (USDA) Office of Civil Rights, this institution is prohibited from discriminating on the basis of race, color, national origin, disability, age, sex, and in some cases religion and political beliefs.
The USDA also prohibits discrimination against its customers, employees, and applicants for employment on the basis of race, color, national origin, disability, age, sex, gender identity, religion, reprisal, and where applicable, political beliefs, marital status, familial or parental status, sexual orientation, or all or part of an individual’s income is derived from any public assistance program, or protected genetic information in employment or in any program or activity conducted or funded by the Department. (Not all prohibited bases will apply to all programs and/or activities.)
If you wish to file a Civil Rights program complaint of discrimination with USDA, complete the USDA Program Discrimination Complaint Form, found online at http://www.ascr.usda.gov/complaint_ filing_ cust.html, or any USDA office, or call (866) 632-9992 to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W. Washington D.C. 20250-9410, by fax (202) 690-7442 or email at program.intake@usda.gov.
Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877- 8339; or (800) 845-6136 (Spanish).
For any other information dealing with SNAP issues, persons should either contact the USDA SNAP Hotline Number at (800) 221 -5689, which is also in Spanish or call the State Information/Hotline Numbers found online at http://www.fns.usda.gov/snap/contact info/hotlines.html.
To file a complaint of discrimination regarding a program receiving Federal financial assistance through the U.S. Department of Health and Human Services (HHS), write: HHS, Director, Office for Civil Rights, Room 515-F, 200 Independence Avenue, S.W., Washington, D.C. 20201 or call (202) 619-0403 (voice) or (800)537-7697 (TTY).
USDA and HHS are equal opportunity providers and employers.
Filling out the Mississippi Supplemental Nutrition Assistance Program (SNAP) Application Form is the first step toward receiving assistance for food and possibly other needs. This process involves providing personal and financial information to the Mississippi Department of Human Services (MDHS) to assess eligibility. Following are detailed instructions on how to accurately complete the form.
Once the application form is completed and submitted, the MDHS will review the information. An interview may be required as part of the application process, which might be conducted over the phone or in person. The MDHS will work to verify provided information and determine eligibility within 30 days. Applicants may be eligible to receive SNAP benefits within 7 days under certain conditions related to their financial situation and emergency status. Understand that providing accurate and honest information is crucial throughout this process to ensure a smooth and fair assessment of eligibility.
How do I begin the SNAP application process in Mississippi?
To start your application for the Supplemental Nutrition Assistance Program (SNAP) in Mississippi, fill out the MDHS-EA-900 form with your name, address, and signature of a responsible member of your household or an authorized representative. Your application process kicks off the moment this form is received at the office, which is crucial for eligibility determination.
What information do I need to provide for a SNAP application?
You must furnish details about your household's income, assets, and expenses, including rent or mortgage, utilities, and any income expected within the month. Additionally, you'll need to provide personal information such as Social Security numbers for each household member included in the application and disclose if any member has been disqualified from SNAP due to fraud or convicted of a drug-related felony since August 22, 1996.
Can I be interviewed over the phone for my SNAP application?
Yes, while an interview is a required part of the SNAP eligibility process, it can be conducted over the phone as an alternative to a face-to-face meeting. Telephone interviews are considered on a case-by-case basis, mainly due to household hardships, to make the application process more accessible.
What are the quick eligibility criteria for receiving SNAP within 7 days?
Quick eligibility for SNAP benefits, possibly within 7 days, hinges on a few specific criteria. Your household can qualify if its gross monthly income is under $150, and assets are $100 or less, or if your combined monthly income and liquid assets are less than your rent/mortgage and utility bills. This expedited service is also available to migrant or seasonal farm worker households, contingent on verifying identity.
Who can apply for SNAP benefits in Mississippi?
Applications for SNAP benefits can be submitted by U.S. citizens and qualified aliens. However, an application can exclude non-citizens or non-qualified aliens without the threat of them being reported to Immigration and Customs Enforcement. It's important to remember that including non-citizens could affect the eligibility verification process under SNAP rules, as the income and resources of all household members are considered in determining eligibility.
Filling out the Mississippi SNAP Application form can be a complex process, and making mistakes can delay or affect the approval of benefits. Here are six common mistakes to avoid:
By avoiding these mistakes, applicants can ensure their application is processed efficiently, helping them to receive the assistance they need without unnecessary delay.
When applying for the Supplemental Nutrition Assistance Program (SNAP) in Mississippi, individuals and families often need to provide several other forms and documents as part of the application process. These documents are crucial in verifying the information provided in the application and determining eligibility for the program.
Collecting and submitting the correct documentation alongside the Mississippi SNAP Application is a key step in accessing the nutritional support provided by the SNAP program. By providing accurate and complete information, applicants can facilitate a smooth and timely review of their application. It is always advisable to consult the latest guidelines from the Mississippi Department of Human Services or seek assistance from a legal advisor to ensure compliance with all requirements.
The Medicaid Application form is quite similar to the Mississippi SNAP Application in that it requires detailed information on household income, assets, and personal identification. Like the SNAP application, applicants must provide their name, date of birth, social security number, and address. Both forms serve as gateways to assistance programs designed to support individuals and families in need, focusing on health care access for Medicaid and food assistance for SNAP.
The Unemployment Insurance Benefits Application shares similarities with the SNAP Application by necessitating personal identification details, income information, and employment status. Both applications assess eligibility based on financial need and include sections where applicants must disclose their current employment situation or lack thereof, aiming to support those experiencing hardship.
The Free Application for Federal Student Aid (FAFSA) parallels the SNAP Application in its requirement for detailed financial information from applicants and their families, including income, assets, and household size. Both forms determine eligibility for federal assistance, with one focusing on educational financial aid and the other on nutritional support, demonstrating a systemic approach to aiding diverse needs.
The Temporary Assistance for Needy Families (TANF) Application is closely aligned with the SNAP form as both target financial help towards families in distress. Applicants must detail their financial situation, family composition, and meet certain criteria to qualify for aid. Both programs are managed by the Department of Human Services, emphasizing government efforts to alleviate poverty.
The Public Housing Application, while focused on providing affordable housing solutions, requires applicants to disclose similar personal and financial information as the SNAP Application. This includes household income, family size, and additional resources, demonstrating a comprehensive approach to assess eligibility for government-assisted services.
The Supplemental Security Income (SSI) Application is another document related to the SNAP Application, as it asks for extensive personal identification, financial, and medical information. Both aim to support individuals who are elderly, blind, or disabled, ensuring they have access to necessary resources, with SNAP focusing on nutrition and SSI on monetary assistance.
The Energy Assistance Program (LIHEAP) Application shares the SNAP Application's goal of aiding low-income households to manage essential expenses. While LIHEAP assists with energy costs, both applications require financial and household information to determine eligibility for support, acknowledging the variety of needs among underserved populations.
The Women, Infants, and Children (WIC) Program Application is akin to the SNAP Application in its focus on providing nutritional support, though WIC targets a more specific demographic. Both applications collect information on household size, income, and residency status to allocate benefits effectively, emphasizing the importance of nutritional health in vulnerable groups.
The Childcare Assistance Application, similar to the SNAP form, assesses families' financial situations to provide necessary support—this time, in the form of subsidies for childcare. By detailing income, family size, and employment information, both applications work towards relieving the financial burdens on families, enabling parents to work or pursue education.
Filling out the Mississippi SNAP Application form is a critical step toward receiving nutritional assistance. To ensure a smooth process and maximize your chances of approval, there are specific actions you should embrace and others to sidestep. Here's a guide to help you along the way:
Things You Should Do:
Things You Shouldn't Do:
By following these guidelines, you can navigate the application process more effectively and improve your chances of receiving the assistance you need.
Many individuals and families who consider applying for SNAP benefits in Mississippi encounter misconceptions about the application process. Understanding these misunderstandings is crucial for a successful application. Here are six common misconceptions about the Mississippi SNAP Application Form:
Dispelling these myths is vital in ensuring that all eligible individuals and families have the information they need to apply for SNAP benefits confidently and correctly in Mississippi.
When applying for the Supplemental Nutrition Assistance Program (SNAP) in Mississippi, it is crucial to understand the key aspects of the application process to ensure a smooth and effective effort towards getting the necessary aid. Here are some vital takeaways from the Mississippi SNAP Application form (MDHS-EA-900 Revised 08-01-13) that can assist applicants in navigating the application process more comfortably.
Adhering to these guidelines and requirements is vital for a successful application process. By providing accurate and complete information, applicants can navigate through the steps more effectively. Additionally, understanding the potential for expedited benefits, requirements for interviews, and acknowledging the responsibilities and penalties associated with the SNAP program can significantly influence the outcome of the application process.
Legal Age to Drive a Boat - Essential for boat owners to provide a notarized or witnessed bill of sale or a copy of former state registration if applicable.
Car Registration Mississippi - Includes a reminder for applicants to return the white copy and retain the yellow copy for their records.
Vital Records Jackson Ms - By law, accessing a Mississippi birth certificate is restricted to those with legitimate interest; Form 522 outlines who is eligible and the proof required.