Dss Form 1634B PDF Details

On December 13, 2017, the Department of Social Services released a memo regarding their updated Form 1634B. This form is used to document the circumstances surrounding an applicant's or recipient's homelessness and verify that they meet the eligibility criteria for homeless assistance. The memo outlines specific changes to the form, including new instructions for documenting veteran status and sexual orientation/gender identity. It also clarifies that applicants who are in emergency shelter programs are not considered homeless. Finally, it advises agencies on how to handle cases where an applicant or recipient does not have adequate documentation.

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DSS Form 1634B (JUL 02) Edition of JAN 94 is obsolete.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

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