Form DHR-FSP-2116 at a glance
What it is: State of Alabama Department of Human Resources Supplemental Nutrition Assistance Program (SNAP) Application, to list your household and ask to get SNAP benefits.
Where and when to file: Mail, fax, e-mail or take this application to the SNAP Office in the county where you live. You may also apply online at www.dhr.alabama.gov. You have the right to file an application the same day you contact your county office.
To file an application, you need only complete your name, address, and signature.
What to bring and attach to Form DHR-FSP-2116
Some of the things you should bring to your interview include: proof of identity (driver's license, birth certificate), proof of income (check stubs, award letter, child support statement, signed statement from person that gives you money), and proof of expenses (power, water and gas bills, rent receipts, mortgage, property tax, house insurance premium, day care receipts, child support orders and receipts, and medical bills for disabled and aging members).
If you have expenses that you do not report and/or provide proof of, you will not receive the deduction for the expense.
A filled-in Form DHR-FSP-2116 example: a parent applies for SNAP
How to fill out Form DHR-FSP-2116, box by box
Interview and preferred language
Check here if you prefer a telephone interview or a face-to-face interview and select your preferred language: English, Spanish or Other.
Your name, address and Social Security Number
Enter YOUR NAME (First, Middle, Last), Birth date (Month, Day, Year) and Social Security Number (Applicants Only), then the Mailing Address and the Street Address, if different.
Enter City, County, State, Zip and Daytime Phone.
Providing a SSN for each household member is voluntary. However, failure to provide a SSN for each household member will result in disqualification of that member.
Your signature and the date
Enter your Signature and the Date.
Expedited services
Expedited services: You may get SNAP benefits within 7 calendar days if your SNAP household has less than $150 in monthly gross income and liquid resources (cash, checking or savings accounts) of $100 or less; or your rent/mortgage and utilities are more than your household's combined monthly income and liquid resources; or a member of your household is a migrant or seasonal farm worker (checked October 19, 2026).
Enter how much money the members of your household have in cash or in a bank account, the total amount of income you expect your household to receive this month, your current monthly rent/mortgage payment and Utilities other than phone.
Is anyone in your household a migrant or seasonal farm worker? Yes or No. If yes, answer these questions: Did all of your household income stop recently? Yes or No. Does anyone in your household expect to receive income from a new source this month? Yes or No. If yes, how much?
Check Yes or No, and enter Where if Yes: Have you or anyone in your household received or do you expect to receive SNAP benefits from any other county in Alabama or any other state this month? Check Yes or No: Did anyone in your household receive SNAP benefits last month?
Household members
Please print clearly.
Please list everyone who lives in your household and answer all questions for each household member that you are asking to get SNAP benefits.
You only have to give social security numbers (SSN) and citizenship/immigration information for those household members that you are asking for SNAP benefits.
You will have to give information such as income for household members who are not seeking benefits to determine if the persons for whom you are applying are eligible to receive benefits.
Enter the Name (First, Middle, Last), Social Security Number (SSN), Birth Date (Month, Day, Year), Relation to you, Working (Yes or No), In school (Yes or No), Sex (M/F), Ethnicity*, Race* and U.S. Citizen (Yes or No). *This information is voluntary. List all races that apply only if the person is asking for benefits.
Use another sheet of paper to add members if there is not enough spaces .
Your benefits will not be affected if you don't answer the ethnicity or race items (the agency will choose for you if you do not answer).
Citizenship/immigration information is used to determine eligibility for SNAP. Providing citizenship/immigration information is voluntary. Failure to provide this information for each household member will result in disqualification of that member.
Other people who live in the same house
List any other people who live in the same house with you but you do not want included in your SNAP household because they do not purchase and prepare food with you.
Enter the Name, Age and Relation to you.
Does this person give you or anyone listed on the form any money? YES or NO. If Yes, enter the reason.
Does this person pay any part of the household bills? YES or NO. If Yes, enter the reason.
Use another sheet of paper to add members if there is not enough space for everyone here.
Authorized Representative
You may appoint someone outside your household to act for your household, to make an application and to be interviewed.
If you want to appoint someone for this, write his/her name here.
You are still responsible for the information that anyone acting as your authorized representative gives, including any information that may be incorrect.
Voter Registration
If you are not registered to vote where you live now, check one box: Yes, I would like to register to vote; Yes, I am registered but would like to change my address for voting purposes; or No, I do not want to apply to register to vote.
If you do not check either box, you will be considered to have decided not to register to vote at this time.
Signing under penalty of perjury
I certify under penalty of perjury that my answers to all questions about each household member, including those about citizenship or alien status, are correct and complete.
Sign the Household member signature or mark (X) line and enter the Date. Witness if signed by mark: sign and enter the Date.
Penalty Warnings, Perjury Statement and Signature: DO NOT REMOVE. The signature page must be returned to your county office with pages 1 and 2.
More rules for Form DHR-FSP-2116
When your household receives SNAP benefits, you must follow all the rules. You must provide true and complete information about everyone in your household, and you must provide documents to prove what you say if you are asked to by the worker.
DO NOT give false information or hide information to get or continue to get SNAP benefits. DO NOT trade or sell EBT cards. DO NOT alter EBT cards to get SNAP benefits you are not entitled to receive. DO NOT use SNAP benefits to buy ineligible items such as alcohol and tobacco or to pay on credit accounts. DO NOT use someone else's SNAP benefits or EBT card for your household.
Common questions about Form DHR-FSP-2116
Where do I file it?
To get the address or phone number of your local county office, call toll free: 1-833-822-2202 or online at www.dhr.alabama.gov.
Is there a penalty?
Any member of your household who breaks any of these rules on purpose can be barred from SNAP for 1 year for first offense, 2 years for second offense, and permanently for third offense; fined up to $250,000, imprisoned up to 20 years or both; and subject to prosecution under other federal laws (checked October 19, 2026).
Where to get help with Form DHR-FSP-2116
If you need help filling out this application due to disability, an interpreter or translated materials, ask for help at your local SNAP Office.
Sources
[1] Form DHR-FSP-2116 (09/26), Supplemental Nutrition Assistance Program (SNAP) Application, State of Alabama Department of Human Resources (the Official source link on this page).
