Dfa Form 768 – Fill Out and Use This PDF

The DFA Form 768 is the Shared Shelter Statement issued by the New Hampshire Division of Family Assistance. You need this form when you share housing with others while applying for or receiving SNAP food assistance. It asks about each person in your home, their relationship to you, and how shelter costs are divided. You report your monthly share of rent, heating, utilities, and telephone costs. Submitting this form accurately helps ensure your food assistance benefits reflect your actual living expenses.

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Dfa Form 768 PDF Details

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

How to Edit Dfa Form 768 Online for Free

Using the online PDF editor at FormsPal, you can fill out and sign the DFA Form 768 in minutes. No software download is needed. The tool works in your browser on desktop and mobile devices.

What You Need Before Starting

Gather these details before you begin:

Your full name, mailing address, and case number from prior DFA correspondence
The names of all people living in your household and their relationship to you
Information about your lease or rental agreement and whose name is on it
Your monthly share of rent, heating, electric, telephone, and internet costs
Details about how food costs are split among the people in your home

Steps to Complete the Form

Step 1: Click the orange "Get Form" button above. This opens the FormsPal PDF editor and loads your form.

Step 2: Complete section one. Enter your client name, physical address, mailing address, case number, and telephone number in the fields provided.

Step 3: Move to section two. List every person in your household. For each person, note their relationship to you and whether their name is on the lease. Check the appropriate boxes for how you share food costs. Take extra care with the "Yes" checkboxes throughout this section. Errors here are among the most common reasons a form needs to be resubmitted.

Step 4: Complete section three. Report your individual share of rent, room and board, heating, electric, telephone, and internet costs. Provide your client signature and today's date. Return the completed form to Centralized Scanning at the DFA.

Completing section 3 of DFA Form 768 with signature and date

Step 5: Review every field for accuracy. When you are satisfied with your entries, click "Done" to save the completed form. You can download, print, or share it from your FormsPal account.

Related NH Division of Family Assistance Forms

You may need to complete additional forms as part of your NH food assistance application. These related forms are available on FormsPal:

DFA Form 756 - another Division of Family Assistance document used in the New Hampshire benefits process
DFA Form 778 - a DFA supplemental form often used alongside the 768 for assistance applications
DFA SNAP-2 Form - the New Hampshire SNAP application supplement form
DFA Form 1239 - another New Hampshire Division of Family Assistance form available online

Common Questions About DFA Form 768

Who needs to submit this form?

Anyone applying for or receiving SNAP benefits in New Hampshire who shares housing with people outside their immediate food assistance unit must submit this form. It clarifies how costs are divided when multiple households share one address.

What is a shared shelter arrangement?

A shared shelter arrangement means two or more people share a home but purchase and prepare food separately. The form documents this arrangement so the state can calculate accurate benefit amounts for each household at the same address.

Where do I submit the completed form?

Return the completed form to Centralized Scanning at the NH Division of Family Assistance. Your DFA caseworker can provide the correct mailing address or fax number for your specific case and district.

How long does the form take to complete?

Most applicants complete the DFA Form 768 in about 15 minutes. Having your household details, lease information, and expense amounts ready before you start will speed up the process.