For residents of South Carolina approved for food stamps through the Elderly Simplified Application Project (ESAP), navigating the requirements to ensure continued eligibility and accurate benefit levels is critical. In this sphere, the DSS Form 16181 emerges as an essential document, serving as a change report form that beneficiaries must use to inform the Department of Social Services (DSS) about significant life changes. This includes moving to a new address which can affect shelter and utility costs, changes in household composition such as someone moving in or out, alterations in child support obligations, and variations in both unearned and earned income. Importantly, the form outlines specific thresholds for reporting income changes, stipulating a $50 change for public sources and a $100 change for private sources. Additionally, starting employment and receiving the first paycheck is a critical change that must be reported. The form emphasizes the urgency of reporting, with a 10-day window from the recognition of change for most updates, ensuring that adjustments in food stamp benefits are promptly and accurately made. Keeping this form until a change occurs, and knowing how to report these changes—via mail, in person, or over the phone—is fundamental for ESAP participants to maintain their benefits and comply with state requirements.
| Question | Answer |
|---|---|
| Form Name | Dss Form 16181 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | esap forms, SCDSS, pensions, unearned |
South Carolina Department of Social Services
CHANGE REPORT FORM
FOR THE ELDERLY SIMPLIFIED APPLICATION PROJECT (ESAP)
This is a change report form. Please keep this form until you have one of the changes below. You have been approved for food stamps through the Elderly Simplified Application Program (ESAP). As a food stamp recipient, there are certain changes you must report.
You must report within 10 days from the date you learn about the change:
1.If you move and have any new shelter and utility costs resulting from the move. New Address:
New Shelter Costs – Rent: |
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Mortgage: |
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Property Taxes: |
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Homeowner’s Insurance: |
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Do you pay for heating or cooling costs? |
Yes |
No |
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If no, what utilities do you pay? |
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2.If someone moves in or out of your household. Tell us who moved into your household:
Name: |
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Relationship to You: |
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Social Security Number: |
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Date of Birth: |
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Do you purchase and prepare your meals together? |
Yes |
No |
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Tell us who moved out of your household: |
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3.If you pay child support and the legal obligation of the amount of this child support changes. What is the new amount of child support you pay?
You must report any change in the source or in the amount of unearned income received from a public source (for example, social security, SSI, Veterans benefits, unemployment compensation) if the amount changes by more than $50 a month. This must be reported no later than 10 days after you receive the changed amount.
Source of Income: |
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Who receives this? |
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Old Amount: |
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New Amount: |
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Source of Income: |
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Who receives this? |
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Old Amount: |
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New Amount: |
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You must report any change in the source or in the amount of unearned income received from a private source (for example, retirement/pensions, child support, cash from friends/relatives) if the amount changes by more than $100 a month. This must be reported no later than 10 days after your receive the changed amount.
Source of Income: |
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Who receives this? |
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Old Amount: |
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New Amount: |
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Source of Income: |
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Who receives this? |
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Old Amount: |
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New Amount: |
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You must report if you go to work no later than 10 days from the date you receive your first check.
Name of Employer: |
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Date of First Paycheck: |
Please keep this form until you have one of the above changes. Do not send this form in unless you have changes! To report changes, send this form to SCDSS, ESAP, P.O. Box 1520, Columbia, SC
DSS Form 16181 (JUN 06)