Form 508: Georgia SNAP/Medical Assistance/TANF Renewal Form

Under Client Name, print the name and address of the person who is reapplying for benefits.

Enter the Client Name, Date of Birth and Social Security Number; the Social Security Number is optional for Non-Applicants.

Mark Yes or No for Are you homeless?

Enter the Street Address, the Mailing Address, the Main Phone Number and the Other Contact Number.

Under Electronic Communication, mark Email Yes or No and Texting Yes or No (optional); the Email Address is optional.

For Email Communication, you must provide your email address and accept the terms and conditions for paperless notices located in GA Gateway Customer Portal after you create an account.

For Texting Communication, you must provide your phone number.

Enter your Preferred Language. If an interview is required, mark Yes or No for will you need an interpreter?

Mark Yes or No for Do you have a disability that will require a Reasonable Modification or Communication Assistance? If yes, please describe the reasonable modification or Communication Assistance that you are requesting.

Check all that apply, or fill in Other.

Mark one-time or ongoing. If possible, briefly explain when and how long you need this modification or assistance.

You declare under penalty of perjury to the best of your knowledge and belief that the person(s) for whom you are applying for benefits is/are U.S. citizen(s) or are noncitizen(s) lawfully present in the United States.

Sign and date on Signature and Date. Witness Signature if signed by 'X', with Date.

Complete this section only if you want a person or an organization to fill out your application/renewal, complete your interview for SNAP or TANF, and/or use your SNAP EBT card to buy food when you cannot go to the store.

Check for each program type who you want to designate as an authorized representative, and check which duties you want the person or organization to have.

Fill out the chart about the applicant and all household members.

Anyone who is living in your household and is not applying for benefits may be treated as a non-applicant. Non-applicants do not have to give information about their Social Security number, citizenship, or immigration status and are not eligible for benefits.

If you want DFCS to decide whether any household members are eligible for benefits, you will still need to tell about their citizenship or immigration status and give their Social Security number (SSN).

Your household is not required to give the Race/Ethnicity information, and it will not affect your eligibility or benefit level.

Please answer only the questions about the benefits you want to receive on the page.

For SNAP, TANF, and Medical Assistance, mark Does anyone in your household work? Yes or No. If yes, list information of the employed person's pay from employment, such as wages, bonuses, and tips, and attach proof of ALL gross income received in the last 4 weeks.

Mark Yes or No for Does anyone in your household receive money from Contributions, Social Security, SSI, VA, Child Support, Unemployment, Retirement, or any other income. If yes, complete the information and provide proof of all income received in the last 4 weeks or the most recent award letter.

Mark Did you or any household member start paying shelter costs or did your shelter costs change? Yes or No. If yes, complete the chart.

If you are not registered to vote where you live now, would you like to apply to register to vote here today? Check Yes, No, or I do not want to answer the Voter Registration question.

If you do not check either box, you will be considered to have decided not to register to vote at this time.

For Medical Assistance only, sign here when the Applicant/Member/Legal Guardian is completing: if "I am applying for/renewing Medicaid for myself", you declare under penalty of perjury that you are a U.S. Citizen, U.S. National and/or qualified immigrant present in the United States.

If you are a parent or legal guardian, you declare that the applicant(s) is a U.S. Citizen, U.S. National and/or qualified immigrant in the United States.

Sign and date at (Signature) (Date).

For Medical Assistance only, sign here when a Person Other Than Applicant/Member/Parent/Legal Guardian is completing: you certify to the best of your knowledge and belief that the person(s) for whom you are applying for/renewing Medicaid is/are U.S. citizen(s), U.S. National(s) and/or qualified immigrant or are lawfully present in the United States.

Enter the phone where you can be reached.

If the Applicant/Member/Parent/Legal Guardian wants this person as the personal representative, she or he must check here and sign below, Yes or No.

For SNAP and/or TANF, sign here when the Applicant/Recipient/Legal Guardian is completing.

An Authorized Representative signs and dates at Authorized Representative's Signature Date.

Form 508 is the Georgia Department of Human Services SNAP/Medical Assistance/TANF Renewal Form. You may use this form to file a joint renewal/application for the SNAP/Medical Assistance and/or TANF program or for SNAP only.

Return this form prior to the certification end date to begin the renewal process. If you receive TANF or Medical Assistance, you must report all changes in your situation within 10 days of the change occurring. If you receive SNAP, you must report when your household's total monthly gross income is more than 130% of the Federal Poverty Level for your household size. You must report the change in income no later than 10 days from the end of the month in which the change occurred.

Anyone in your household who breaks any of the SNAP rules on purpose can be barred from SNAP from one year to permanently, fined up to $250,000, imprisoned for 20 years or both (checked October 20, 2026).