Form FS-1: Missouri SNAP Food Assistance Application

Benefits are provided from the date FSD receives your application, which must contain your name, address and signature. Please complete sections 2 through 6 to help FSD process your application faster.

Enter your Full Legal First Name, Middle Name and Last Name.

If you are homeless, check the box I am homeless.

Enter your Home (Physical) Address: Street, Apt/Building/Suite/Trlr #, City, State, Zip and County.

Enter a Mailing Address if it is different than the Home (Physical) Address: Street/PO Box, Apt/Building/Suite/Trlr #, City, State, Zip and County.

Check the best way to contact you: Call, Email, Mail or Text (not available everywhere).

Sign and date: Under the laws of the State of Missouri, and the regulations of the United States Department of Agriculture, I hereby apply for SNAP benefits.

If eligible, you may be able to receive SNAP within 7 days of filing your application if you answer “yes” to any of the questions in this section. Otherwise, you will receive your benefits within 30 days of filing your application.

1. Is your household's monthly gross income less than $150 and do you have $100 or less available in cash and/or in a bank account? (checked October 19, 2026)

2. Is your household's combined monthly gross income and cash on hand or money in checking and savings accounts less than the combined cost of rent/mortgage and utilities?

3. Is anyone in your household a migrant or seasonal farm worker whose income has stopped and has less than $100 in cash and bank accounts? (checked October 19, 2026)

Before you can receive SNAP, FSD must verify your identity. FSD will try to verify your identity electronically; but it may be helpful to (1) include a copy of your identification, or (2) bring someone who knows you to any FSD office, or (3) list a contact here to help FSD verify your identity. FSD will call this person if needed. Enter the Name of person to verify your identity and the Phone Number.

Write your information on the first line.

Enter the information of all the people who live at your address, including your spouse, any children under age 22 who are in your household at least half (50%) of the time, significant others with children in common, and anyone who eats most of their meals in your household.

Include all household members regardless of their citizenship or immigration status.

Providing the Social Security Number (SSN) and immigration status of each household member is voluntary. However, you will not receive SNAP benefits for individuals who do not provide a SSN and/or immigration status. Citizenship or Immigration status does not automatically disqualify an applicant from receiving SNAP benefits.

Mark “Y” in the “Buy & Eat” field for everyone you buy, cook and/or eat with in the household and “N” for those who are responsible for purchasing and preparing their own food.

List anyone who is a boarder in your household, anyone who is a foster child or foster adult in your household, and anyone who is not a U.S. citizen in your household.

4. Do you need a new Missouri EBT card? Yes No 5. Is English your preferred language? Yes No If no, what is the language spoken most often in your home?

Answer “yes” or “no” to each of the questions in this section. Please provide the name of the household member for whom the answer is “yes”.

A “yes” response to any of the questions in this section (or incorrectly marking “no”) may result in a disqualification for SNAP benefits for the person to whom the “yes” answer applies.

Answer the questions for yourself and all the people who live with you (as listed in section 3). 1. Has anyone received SNAP benefits in a state other than Missouri within the past 30 days? If yes, please fill in the details for anyone who received benefits in another state: Who received benefits? First Name Last Name, State County Date last received?

Resources: Resources are bank accounts and other types of money you own by yourself or with other people. Does anyone have or is anyone's name on any checking or savings accounts, debit cards, CDs, IRAs or other type of retirement accounts, trusts, stocks, bonds, or digital cash accounts? Yes No If yes, please list the information for the account(s): Who Owns? Account Type: Balance/Cash Value: Bank Name: First Name Last Name

Income: Income is money that's paid to you, such as earnings from a job or payments from Social Security or child support.

1. Has anyone's income stopped or been reduced in the last 30 days? Yes No If yes, list whose income has stopped or reduced, the name of the employer, the date and gross amount of the final paycheck, and if the separation/reduction was voluntary:

2. Does anyone earn income or money from working, or is anyone working in exchange for goods and services (in-kind work)? If yes, list who gets it, their employer with contact number (if known; if self-employed, write “self” under employer), and gross income (before taxes or deductions), and how often they are paid (weekly, bi-weekly, monthly, etc.):

Expenses: Expenses are the bills you are responsible for paying. 1. Does anyone pay the following expenses for the home you live in? Who pays? Does it heat or cool your home? If yes, check all that apply: Amount per month YOU pay: First Name: Last Name:

Please note if your rent includes any utilities. Leave taxes and insurance blank if these are included in the house payment.

Read this section carefully before signing. You are certifying, under penalty of perjury, you understand the information that you provide on this form and during the interview must be true and accurate, including information concerning citizenship and immigration status.

You understand that any expenses you do not report, and verify when requested, will not be used to determine your SNAP benefits.

Sign here: enter Your Signature and the Date.

You can choose more than one person or facility to complete your application and/or manage your benefits on your behalf. They will act as your authorized representative. If you want an authorized representative, complete the Authorized Representative Form (IM-6AR) at https://dssmanuals.mo.gov/wp-content/uploads/2020/09/im-6ar-app.pdf or call FSD.

Application for Supplemental Nutrition Assistance Program (SNAP), form FS-1, to apply for SNAP benefits under the laws of the State of Missouri. Once your application is processed, you will get a letter that lets you know if you are eligible for SNAP benefits or not.

FSD must process your application within 30 days.

Upload: mydssupload.mo.gov. Mail: Family Support Division PO Box 2700 Jefferson City, MO 65102. Fax: 573-526-9400. In Person: Find an office: dss.mo.gov/offices.htm.

Any member who breaks any of the rules on purpose can be ineligible from the SNAP Program for one year, up to permanently, fined up to $250,000, imprisoned up to 20 years or both (checked October 19, 2026).