Dss Form 1634B PDF Details

Navigating the intricacies of the food assistance landscape can often be challenging, particularly when unforeseen circumstances lead to the loss of benefits or resources. One critical pathway for addressing such challenges within South Carolina's Food Stamp Program involves the DSS 1634B form, an affidavit designed to address loss due to a benefit group misfortune. Essentially, this document serves as a formal declaration by participants that purchased food, intended for sustenance and nourishment, was destroyed due to circumstances beyond their control. Completing this form requires the applicant to detail the amount lost and explain the incident under penalty of perjury or fraud, adhering to the program's rigorous standards for honesty and accuracy. Furthermore, the form outlines a process for both the applicant and the Department of Social Services (DSS), including verifications of the incident for authorized replacement of food benefits. The DSS’s meticulous process—as indicated by the requirement for signatures of the worker, supervisor, and the claimant—not only underscores the seriousness with which claims are treated but also the department's commitment to ensuring that aid reaches those in genuine need. With copies distributed among the involved parties for transparency and record-keeping, the DSS Form 1634B symbolizes a crucial support mechanism within the safety net provided by food assistance programs, ensuring those affected by misfortune do not face an additional burden of hunger.

QuestionAnswer
Form NameDss Form 1634B
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namessc dss form 1634b, EBT, JAN, Coordinator

Form Preview Example

South Carolina Department of Social Services

Food Stamp Program

AFFIDAVIT OF LOSS DUE TO A BENEFIT GROUP MISFORTUNE

Case Name:

 

Case Number:

I hereby certify, under penalty of perjury and/or fraud that the food purchased with food stamp benefits was

destroyed onin the amount of $ under the following circumstances:

Client’s Signature:

 

Date:

 

 

 

 

 

FOR DSS USE ONLY

Replacement of food authorized; verification: (Attach verification)

Benefit Month:

 

Amount $

Replacement of food denied, reason:

Worker’s Signature:

Date:

Supervisor’s Signature:

Date:

DISTRIBUTION: Canary copy to recipient; Pink copy filed in case file; White copy retained by the EBT Coordinator

DSS Form 1634B (JUL 02) Edition of JAN 94 is obsolete.

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Writing part 1 in certify

2. Soon after the last array of blank fields is filled out, go on to enter the relevant details in these - Benefit Month, Amount, cidcidcidcid Replacement of food, Workers Signature, Supervisors Signature, Date, Date, and DISTRIBUTION Canary copy to.

How one can complete certify part 2

It is easy to get it wrong when filling out the Workers Signature, hence you'll want to reread it prior to when you finalize the form.

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