The DFA Form 768 is the Shared Shelter Statement from the New Hampshire Department of Health and Human Services (DHHS), Division of Family Assistance. It was last updated in August 2017. This form is used when two or more people share a home but operate as separate households for food assistance purposes.
The form is divided into three sections. The first section collects your personal information. You enter your full name, physical address, mailing address, case number, and telephone number.
The second section covers your household members. You list each person in the home, their relationship to you, and whether their name is on the lease. You also indicate how food costs are shared. For each person, you note whether they purchase and prepare food separately from you.
The third section documents your financial responsibilities. You report your monthly share of rent, room and board, heating, electric, telephone, and internet costs. You also provide your signature and the date before returning the form to the Division of Family Assistance.
Accurate completion of this form allows the NH Division of Family Assistance to correctly calculate your SNAP benefit amount based on your actual shelter expenses.
| Question | Answer |
|---|---|
| Form Name | Dfa Form 768 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | dfa 768, dfa forms 768 or 775, nh shared, nh dfa form 768 |