Ga Form 508 PDF Details

Ga form 508 is a document that must be filed with the state to create an official business entity. The form can be filled out online or downloaded and printed. There are many benefits to incorporating your business, and ga form 508 is the first step in making that happen. By filing this form, you are creating a legal entity that will have its own distinct identity separate from its owners. This can be helpful for tax purposes and in protecting your personal assets in the event of legal action against your company. Filing ga form 508 is easy and can be done online in just a few minutes.

The listing contains specifics of the ga form 508. It is worth spending some time to study this before you begin filling in your document.

QuestionAnswer
Form NameGa Form 508
Form Length19 pages
Fillable?Yes
Fillable fields591
Avg. time to fill out30 min 45 sec
Other nameshow do i renew my food stamps online in georgia, food stamp renewal form, ga form renewal, renew food stamps

Form Preview Example

Georgia Department of Human Services

FOOD STAMP/MEDICAID/TANF Renewal Form

If you need help reading or completing this document or need help communicating with us, ask us or

call 1-877-423-4746. Our services, including interpreters, are free. If you are deaf, hard-of-hearing, deaf-blind or have difficulty speaking, you can call us at the number above by dialing 711 (Georgia Relay).

For Office Use only: Date Received Load #

 

Client ID # _____________Date Initiated_________________

Programs Initiated: TANF Food Stamps Medicaid

 

If you are reapplying for Food Stamps or renewing your TANF or Medicaid benefits, you can file this renewal/application form with only your name, address and signature. However, it will help us to process your application, recertification/renewal more quickly if you complete the entire form and provide verification of information, if it is requested. You may use this form to file a joint renewal/application for the Food Stamp/Medicaid and/or TANF program or for the Food Stamp Program (FS) only. Your Food Stamp renewal will not be terminated solely on the basis that your renewal/application for another program has been denied/terminated. We will make a separate eligibility determination for your Food Stamp renewal.

Please PRINT the name and address of the person who is reapplying for benefits in the space below:

Client Name:

 

Date of Birth:

Social Security Number:

 

 

 

 

Street Address:

 

 

 

 

 

 

 

 

 

 

 

Mailing Address:

 

 

 

 

 

 

 

 

 

 

 

Main Phone Number:

 

Other Contact Number:

Email Address:

 

 

 

(Optional)

 

 

 

 

E-mail Communication Yes___ or No___

(optional)

Texting: Yes__ or No__(optional)

 

 

 

 

 

What is your Preferred Language?

 

If an interview is required, will you

 

 

 

need an interpreter?

Yes ____ or No ____

 

 

 

 

Americans with Disabilities Act: Request for Reasonable Modification & Communication Assistance (if applicable):

Do you have a disability that will require a Reasonable Modification or Communication Assistance? Yes__ No ___

(If yes, please describe the reasonable modification or Communication Assistance that you are requesting):

Sign Language interpreter ___; TTY ____; Large Print ____; Electronic communication (email) ____; Braille ____; Video

Relay ___; Cued Speech Interpreter___ ; Oral Interpreter ___; Tactile Interpreter ___; Telephone call reminder of program deadlines ___; Telephonic signature (if applicable) ___; Face-to-face interview (home visit) ___; Other:_______

Do you need this Reasonable Modification or Communication Assistance one-time ___ or ongoing ___? If possible, briefly explain when and how long you need this modification or assistance?

__________________________________________________________________________________________

Form 508 (Rev. 09/20)

- 1 -

I declare under penalty of perjury to the best of my knowledge and belief that the person(s) for whom I am applying for benefits is/are U.S. citizen(s) or are noncitizen(s) lawfully present in the United States. I further certify that all of the information provided on this application is true and correct to the best of my knowledge. I understand and agree that DHS-DFCS, DCH and authorized Federal Agencies may verify the information I give on this application. Information may be obtained from past or present employers. I understand that my information will be used to track wage information and my participation in work activities.

I will report any change in my situation according to Food Stamp/Medicaid and/or TANF program requirements. I will also report If anyone in my household receives lottery or gambling winnings, gross amount of $3500 or more (before taxes or other amounts are withheld). I will report these winnings within 10 days from the end of the month in which my household receives the winnings. I understand if any information is incorrect, my benefits may be reduced or denied, and I may be subject to criminal prosecution or disqualified from DHS-DFCS programs for knowingly providing incorrect information. I understand that I can be prosecuted if I provide false information or hide information. I understand that if I fail to tell DHS-DFCS about some of my expenses at my application or renewal interview and/or fail to verify them that DHS-DFCS will not budget that expense in calculating the amount of my Food Stamp benefits.

Signature:

Date

Witness Signature if signed by ‘X’

Date

Form 508 (Rev. 09/20)

- 2 -

Authorized Representative:

Complete this section only if you want someone to fill out your application/renewal, complete your interview for Food Stamps or TANF, and/or use your Food Stamp EBT card to buy food when you cannot go to the store. If you are applying for Medicaid, you can choose more than one person to apply for Medical Assistance on your behalf.

Name 1: ____________________________________________

Phone:

_________________________

 

Address: ____________________________________________

Apt:

_____________

 

 

City:

____________________________________________

State:

 

______________ Zip: ___________

 

 

 

 

 

Preferred Language: __________________________________

Is an interpreter needed? Yes ____ or

No ____

Name 2: ____________________________________________

Phone:

_________________________

 

Address: ____________________________________________

Apt:

_____________

 

 

City:

____________________________________________

State:

 

______________ Zip: ___________

 

 

 

 

 

Preferred Language: __________________________________

Is an interpreter needed? Yes ____ or

No ____

For Medicaid, do you want this individual to have a copy of your Medicaid card? Yes No

 

Americans with Disabilities Act: Request for Reasonable Modification & Communication Assistance for Authorized Representatives (if applicable):

Does the authorized representative have a disability that will require a Reasonable Modification or Communication Assistance? Yes__ No ___ (If yes, please describe the reasonable modification or Communication Assistance that you are requesting):

Sign Language interpreter ___; TTY ____; Large Print ____; Electronic communication (email) ____; Braille ____;

Video Relay ___; Cued Speech Interpreter___ ; Oral Interpreter ___; Tactile Interpreter ___; Telephone call reminder of program deadlines ___; Telephonic signature (if applicable) ___; Face-to-face interview (home visit) ___; Other:_______

Does the authorized representative need this Reasonable Modification or Communication Assistance one-time ___ or ongoing ___? If possible, briefly explain when and how long you need this modification or assistance? __________________________________________________________________________________

FOR MEDICAID ONLY:

Do you expect to file a federal income tax return NEXT YEAR? (You can still apply for health insurance even if you don’t file a federal income tax return.)

YES If Yes, Please answer questions a, b, and c

NO If No, Please answer question c.

a. Will you file jointly with a spouse? Yes No If yes, name of spouse:

 

b. Will you claim any dependents on your tax return? Yes

No

If yes, list name(s) of dependents: _

 

 

 

c. Will you be claimed as a dependent on someone's tax return? Yes No If yes, list the name of the tax filer: ________________________________

Form 508 (Rev. 09/20)

- 3 -

If you need help reading or completing this document or need help communicating with us, ask us or call 1-877-423-4746. Our services, including interpreters, are free. If you are deaf, hard-of-hearing, deaf-blind or have difficulty speaking, you can call us at the number above by dialing 711 (Georgia Relay).

COMMUNITY OUTREACH SERVICES:

For more information about other DHS services, please visit our website at www.dfcs.georgia.gov or call 1-877-423- 4746.

Please answer all questions and provide proof of all income and any expenses as requested.

CITIZENSHIP IMMIGRATION STATUS AND SOCIAL SECURITY NUMBERS:

Please fill out the chart below about the applicant and all household members. The following federal laws and regulations: The Food and Nutrition Act of 2008, 7 U.S.C. § 2011-2036, 7. C.F.R. § 273.2, 45 C.F.R.

§205.52, 42 C.F.R. § 435.910, and 42 C.F.R. § 435.920, authorize DFCS to request you and your household members social security number(s). 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 us information about their social security number, citizenship, or immigration status and are not eligible for benefits. Other household members may still be able to receive benefits, if they are otherwise eligible. If you want us to decide whether any household members are

eligible for benefits, you will still need to tell us about their citizenship or immigration status and give us their social

 

security number (SSN). You will still need to tell us about their income and resources to determine the eligibility and

 

benefit level of the household. We will not report any non-applicant household members to the United States

 

 

 

Citizenship and Immigration Services (USCIS) Systematic Alien Verification for Entitlements (SAVE) system if they

 

do not give us their citizenship or immigration status. However, if immigration status information has been submitted

 

on your application, this information may be subject to verification through the SAVE system and may affect the

 

household’s eligibility and benefit level. We will match your information with other Federal, state, and local agencies

 

to verify your income and eligibility. This information may also be given to law enforcement officials to use to catch

 

people who are running from the law. If your household has a Food Stamp claim, the information on this application,

 

including SSN, may be given to Federal and State agencies and private claims collection agencies for them to use in

 

collecting the claim. We will not deny benefits to

applicant household members because other household members

 

fail to provide their SSN, citizenship, or immigration status. If you are applying for emergency medical services only,

 

you do not have to provide your SSN or information about your immigration status.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ethnicity

 

 

 

 

 

 

<![endif]>youArea U.S citizen, immigrantqualified or in satisfactorya immigrationstatus? (Applicantsonly) (Y/N)

<![endif]>theDoesmother of this livechildin the home? (Y/N)

<![endif]>theDoesfather of this livechildin the home? (Y/N)

 

<![endif]>wantyouDo Medicaid? (Y/N)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hispanic

 

 

 

 

 

Social

 

 

 

 

 

 

 

 

or

 

 

 

 

 

Security

 

 

 

 

 

 

M

 

Latino?

Race

Sex

 

Date

Relationship

Number

 

 

 

 

 

First Name

I

Last Name

(Optional)

(Optional)

M/F

 

Of Birth

To You

(Applicants only)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Y/N

 

 

 

 

SELF

 

Y/N

Y/N

Y/N

 

Y/N

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Y/N

 

 

 

 

 

 

Y/N

Y/N

Y/N

 

Y/N

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Y/N

 

 

 

 

 

 

Y/N

Y/N

Y/N

 

Y/N

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Y/N

 

 

 

 

 

 

Y/N

Y/N

Y/N

 

Y/N

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Y/N

 

 

 

 

 

 

Y/N

Y/N

Y/N

 

Y/N

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Y/N

 

 

 

 

 

 

Y/N

Y/N

Y/N

 

Y/N

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Y/N

 

 

 

 

 

 

Y/N

Y/N

Y/N

 

Y/N

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Race Codes (Choose all that apply):

 

 

AI – American Indian or Alaska Native

AS – Asian

BL – Black or African American

HP – Native Hawaiian or Other Pacific Islander

WH – White

 

By providing Race/Ethnicity information, you will assist us in administering our programs in a non-discriminatory manner. Your household is not required to give us this information, and it will not affect your eligibility or benefit level. However, if you do not provide this information, visual identification of race and ethnicity will be made during the first face-to-face interview.

Form 508 (Rev. 09/20)

- 4 -

For Medicaid only:

Was anyone in your household in Foster Care at age 18? Yes No

If you have tax dependents that do not live in the home with you, please list below.

 

 

Name:

 

 

 

Social Security Number_

 

 

Sex: M F (please circle

 

 

 

 

 

one)

Date of Birth:

 

 

Citizenship:

 

 

 

 

 

 

 

 

 

 

 

Relationship to you:

 

 

 

(Please add additional pages as needed)

 

 

For Food Stamp Program only - DISQUALIFICATIONS:

(1)Have you or any household member been convicted of giving false information about where they live and who they

are to get multiple FS benefits in more than one area after 8/22/96?

Yes No

If yes, Who:

 

Where:

 

When:

 

 

 

 

 

 

(2)Do you or any household member have a felony conviction because of behavior related to the possession, use or distribution of a controlled substance after 8/22/96? Yes No

If yes, Who:

 

 

When:

 

Date of offense:

 

Date of Conviction:

 

 

Does this person have 1st Offender Status?

Yes No

a)Are you in compliance with any terms of probation related to any sentence received as a result of a drug felony conviction? (For Food Stamps only) Yes No

b)Are you in compliance with the terms of parole related to any sentence received as a result of a drug felony conviction? (For Food Stamps only) Yes No

c)Have you successfully completed all the terms of probation or parole related to any drug related conviction? (For Food Stamps only) Yes No

(3) Is anyone trying to avoid prosecution or jail for a felony?Yes

No

If yes, who

 

 

(4) Is anyone violating conditions of probation or parole?

Yes No

If yes, who

 

 

(5)Have you or any household member been convicted of trading SNAP benefits for drugs after 8/22/96? Yes No

If yes, who;

 

when:

(6)Have you or any household member been convicted of buying or selling SNAP benefits over $500 after 8/22/96?

Yes No

 

If yes, who;

when:

(7)Have you or any household member been convicted of trading SNAP benefits for guns, ammunition or explosives after 8/22/96? Yes No

If yes, who;

 

when:

 

 

(8) Have you or any household member received lottery or gambling winnings?

Yes No

If yes, who: _____________________________________when: ___________________________________

Amount received: ________________________________

For the TANF Program only - DISQUALIFICATIONS

(1) Has anyone been convicted of a violent felony?

Yes No

If yes, who:

 

 

(2)Has anyone been convicted on or after January 1997 of misrepresenting their residency in order to receive TANF

benefits in multiple states?

Yes No

If yes, who:

 

 

Form 508 (Rev. 09/20)

- 5 -

(3)Has anyone been convicted of using the TANF cash assistance or TANF debit MasterCard at prohibited places listed below: liquor stores, casinos, poker rooms, adult entertainment business, bail bonds, night clubs/salons/taverns, bingo halls, race tracks, gun/ammunition stores, cruise ships, psychic readers, smoking shops, tattoo/piercing shops, and

spa/massage salons.

 

Yes No

If yes, who:

 

when:

 

Food Stamps and TANF only:

STUDENTS IN HIGHER EDUCATION: Is anyone in your household enrolled at least half-time in a college, university, vocational or technical school? Yes No If yes, who:

School Name:

 

 

 

Grade/Status

_Graduation date:

 

 

 

 

 

 

 

Is the student employed? Yes No Enrolled in work study?

Yes No

If yes, hours worked per week

 

(Please complete the employment section below as well.)

For Medicaid and TANF Only:

Is anyone in your household pregnant?

Yes No Number of expected births:Name of pregnant woman: __________________________________

Baby’s Due Date: _____________ Unborn baby’s father’s Name: _____________________________________________

Father’s address: ___________________________________________________________________________________

_________________________________________________________________________________________________

MEDICAL:

For Medicaid Only:

Does anyone in the household have any unpaid medical bills? Yes No

If yes, please send the unpaid bills if you have a Medicaid case.

For Food Stamps Only:

Does anyone age 60 or older or disabled have medical expenses? Yes No

Did your medical expenses such as Medicare premiums, prescription drug cost, or hospital bills change? Yes No

If yes, list expenses on chart below. Attach bills, prescription drugs for most recent month(s).

 

Type of Expense

Amou

 

Will

Household Member Billed

Date of Bill

Insurance

(Doctor, Hospital,

nt

 

 

Pay?

 

Prescription)

Owed

 

 

 

Yes/No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Does anyone 60 years of age or older or disabled have medical expenses for transportation? Yes No

If yes, please provide the information below. If you are receiving Medicaid, provide proof:

Purpose of the trip (doctor or hospital visit; pharmacy pick- up)

Total miles driven:

Cost of taxi, bus, parking or lodging:

Does someone else pay any of these medical expenses for you? Yes No

If yes, please provide information below:

Which expense is paid?

 

Who pays the expense?

 

 

 

To whom does this person pay the bills?

 

Address:

 

 

 

Form 508 (Rev. 09/20)

- 6 -

For Medicaid only

OTHER HEALTH COVERAGE

Is anyone enrolled in health insurance now from the following?

Georgia Department of Human Services Medicaid

PeachCare for Kids

Medicare

VA Healthcare Programs TRICARE (Don’t check if you have direct care or Line of Duty)

Employer Insurance: Name of Insurance_

 

 

Policy Number

 

Other: Name of Insurance

 

 

Policy Number

 

 

 

 

Do you have any health insurance other than Medicaid? Yes No If yes, send us a copy of your insurance card.

RESOURCES:

(Not needed for MAGI Medicaid): Does any person in your household have any of the following resources? Yes No(If yes provide the information below. If you are receiving Aged, Blind or Disabled Medicaid (other than Medicare Savings Plans such as QMB, SLMB or QI-1 only) provide proof.

 

 

Account/Policy #

 

 

 

 

 

(Do not complete

 

 

 

Resource Type

Owner

If your

 

Value

Name of Bank, Insurance Company etc.

account/policy #

 

 

 

 

 

 

 

 

is the same as

 

 

 

 

 

your SSN)

 

 

 

Cash

 

 

 

 

 

 

 

 

 

 

 

Checking/Savings

 

 

 

 

 

 

 

 

 

 

 

Credit Union

 

 

 

 

 

 

 

 

 

 

 

Annuities

 

 

 

 

 

 

 

 

 

 

 

Stocks or Bonds

 

 

 

 

 

 

 

 

 

 

 

Safe Deposit Box

 

 

 

 

 

 

 

 

 

 

 

Retirement Account

 

 

 

 

 

(For non-MAGI Medicaid/TANF only)

Vehicles

(For non-MAGI Medicaid/TANF only)

CD’s/Annuities

(For non-MAGI Medicaid/TANF only)

Pre-Paid Funeral Plans

(For non-MAGI Medicaid/TANF only)

Cemetery Plots

(For non-MAGI Medicaid/TANF only)

Trust Funds

(For non-MAGI Medicaid/TANF only)

Non-Home Place Property

(For non-MAGI Medicaid/TANF only)

Home Place Property

(For non-MAGI Medicaid/TANF only)

Life Insurance

(For non-MAGI Medicaid/TANF only)

Other

For Aged, Blind or Disabled Medicaid only:

Have you, your spouse or someone you are applying for sold, traded, or given away a resource in the last 60 months. Yes No

If yes, what?

When?

Form 508 (Rev. 09/20)

- 7 -

Yes No

EMPLOYMENT: Does anyone in your household work? Yes No If yes, list information of the employed person’s pay from employment such as wages, bonus, and tips, and attach proof of ALL gross income received in the last 4 weeks.

PERSON WORKING

EMPLOYER

PAY

PER

HOUR

HOURS

PER

WEEK

HOW

OFTEN

PAID

DATE(S)

PAID

BONUS

PAY

TIPS

For Medicaid only

PRE-TAX EXPENSES:

Health Insurance

$____ How Often?

 

How Often?

 

 

 

_________________

 

 

 

 

 

 

 

 

 

 

Dental Insurance

$

 

 

 

 

 

 

 

How Often?

$

 

How Often?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$_

 

Other Deduction Type:

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

How Often?

 

 

 

 

 

 

 

 

 

Other Deduction Type:

More? Please attach on a separate sheet of paper.

Vision Insurance $

Other Deduction Type:

How Often?Other Deduction Type:

$_

 

How Often?

Pre-Tax expenses are deductions taken out of your income before taxes are applied. Not all deductions are pre-tax.

TAX RETURN DEDUCTIONS:

Check all that apply and give the amount and how often you pay it.

NOTE: You shouldn’t include a cost that you already considered in your answer to self-employment.

Alimony Paid $How Often?Student Loan Interest $_ How Often?

Other Deduction Type

$

How Often?

 

 

 

 

 

Did anyone in your household voluntarily quit a job or voluntarily reduce his/her work hours to below 30 hours per week within the last 30 days of the date of this renewal?

If yes, who quit?

 

Date of quit:

 

 

What Job was quit?

 

 

 

 

Why did he/she quit?

 

 

 

 

Has anyone stopped working? Yes No If yes, complete the following and provide proof:

What job stopped?

 

Name of Household Member who stopped working:

 

 

 

 

Place of employment:

 

 

 

 

 

 

 

Date Pay Stopped:

 

Date of Final Check:

Amount of final Pay (gross):

 

 

 

 

Form 508 (Rev. 09/20)

- 8 -

 

Has anyone started working? Yes No If yes, complete the following and provide proof:

Name of person who started working:

 

Date Started:

 

 

 

Phone Number:

 

 

 

 

 

 

 

 

 

Name of employer/business:

 

 

Rate of Pay:

 

Date

 

first check received/will be

 

 

 

$

 

received:

 

 

 

 

 

 

 

 

 

How often paid (please check one):

 

 

 

 

 

 

 

Weekly

Bi-weekly

Twice a month

Monthly

Other

SELF-EMPLOYMENT:

Is anyone self-employed: YesNo (If yes, who?) ______________________________

Please provide proof of self-employment income through tax files, business records, receipts, bills, or statements from customers of an established business.

Is this business incorporated?

Yes No

Does this person have any self-employment expenses? Yes No

If yes, what type of expenses does this person have?

For Medicaid and TANF only: provide proof for self-employment expenses.

UNEARNED INCOME:

Does anyone in your household receive money from Contributions, Social Security, SSI, VA, Child Support, Unemployment, Retirement or any other income? Yes No

If yes, complete the information below and provide proof of all income received in the last 4 weeks or the most recent award letter.

Name

Source

Amount

How Often?

For MAGI Medicaid: Income from Child support, veteran’s payment, Supplemental Security Income (SSI), or Workman’s Compensation Benefits will not be counted.

DEPENDENT CARE COSTS:

Do you pay for the care of a dependent child or a disabled adult household member? Yes No If yes, complete the questions below; provide proof for Food Stamps (if the monthly amount is over $200).

Person who requires care:

Person who pays for care:

Provider’s Name:

How much provider is paid:

How often paid:

Provider’s Phone #:

Reason for Care:

Do you pay transportation expenses for a dependent child or disabled adult household member? Yes No

Are these expenses included in the dependent care expenses? Yes No

If no, please answer this question: Total miles driven weekly: ________________________

Form 508 (Rev. 09/20)

- 9 -

SHELTER COSTS:

Did you or any household member start paying shelter costs or did your shelter costs change? Yes No

If yes, complete the chart below.

Expense

Amount

How Often?

Who paid?

 

 

 

 

Rent/Mortgage

 

 

 

 

 

 

 

Property Taxes

 

 

 

 

 

 

 

Property Insurance

 

 

 

 

 

 

 

Electricity

 

 

 

 

 

 

 

Gas

 

 

 

 

 

 

 

Fuel oil/Wood/

 

 

 

Kerosene

 

 

 

Well/Septic

 

 

 

Tank/Water/Sewage

 

 

 

Garbage

 

 

 

 

 

 

 

Telephone

 

 

 

 

 

 

 

Other

 

 

 

 

 

 

 

What is the home’s primary heating or cooling source? (electricity, gas, air conditioner)

Does someone else pay any of these household bills for you? Yes No If yes, complete the chart below:

Who pays the bill?

What amount is paid?

What bills are paid?

To whom does this person pay the bills?

Have you received energy assistance in the last 12 months? Yes No

If yes, amount received $

Do you share monthly household expenses with anyone in the home? YesNo

If yes, who?

Comments/Documentation

Paid to whomAmount paid $___________________________ per ________________

Landlord Name ______________________ Landlord Address ______________________________________

CHILD SUPPORT PAYMENT:

 

 

Do you or someone in your household pay child support to someone living outside of the home?

Yes No

If yes, complete the chart below:

 

 

Who is obligated to pay?

How much is the obligated amount?

 

 

 

 

For whom is the child support paid?

How much is the actual amount paid?

 

 

 

 

To whom is the child support paid?

How often is the child support paid?

 

 

 

 

For Food Stamps only, please provide proof of amount paid in the past 3 months and the legal obligation to pay.

This section is FOR TANF RECIPIENTS ONLY – You must complete the following:

Shot Records:

Is there any child under age 7, who is not yet enrolled in school? (Pre-K is not considered “school.”) Yes No

If yes, send Form 3231- Child Care Immunization form for each child under age 7.

Form 508 (Rev. 09/20)

- 10 -

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For each segment, prepare the content demanded by the software.

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Type in the appropriate details in the segment WhatisyourPreferredLanguage, and YesorNo.

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Filling in how do i renew my food stamps online in georgia part 3

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Completing how do i renew my food stamps online in georgia part 5

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