Snap Application Form – Fill Out and Use This PDF

The Snap Application form, officially known as LDSS-4826 (REV. 2/18), is a document provided by the New York State Office of Temporary and Disability Assistance for individuals or families to apply for or recertify for the Supplemental Nutrition Assistance Program (SNAP). This form is designed to determine eligibility for SNAP benefits and can also accommodate individuals with visual impairments by providing them in alternative formats upon request. If you're seeking nutritional assistance or need to renew your SNAP benefits, ensure to complete this application accurately.

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Snap Application Form PDF Details

Understanding the Supplemental Nutrition Assistance Program (SNAP) application form, officially known as LDSS-4826 (REV. 2/18), is vital for residents of New York State seeking assistance with food purchases. The form, provided by the New York State Office of Temporary and Disability Assistance, outlines the process for applying or recertifying for SNAP benefits. It emphasizes the accessibility of the application for individuals who are blind or have serious visual impairments by offering alternative formats like large print, data CDs, audio CDs, and Braille. Additionally, the form specifies that if applying solely for SNAP, a shorter application process is available, although applications for other benefits require different forms. The key stipulation for filing the application includes submitting basic information such as name, address, and signature to establish the filing date. The eligibility criteria allow for applying on behalf of eligible household members regardless of the applicant's immigration status or if the applicant has reached Temporary Assistance time limits. Moreover, the form mentions the possibility of expedited processing for households with little or no income or resources, or for those whose housing costs exceed their income. It also provides guidance on where to apply, highlighting both online and physical locations for submission within and outside New York City. For those facing challenges in attending a SNAP interview, alternatives such as telephone interviews or proxy applications are mentioned. Furthermore, the application process takes into account non-discrimination policies, ensuring equal opportunity access to SNAP benefits. This provision is a testament to the program's compliance with Federal civil rights law, reinforcing the USDA’s commitment to administering these benefits fairly. Individuals are required to provide detailed information about their household, income, resources, and expenses to determine eligibility, which underscores the comprehensive nature of the application process designed to accurately assess need and ensure that aid is directed to those who require it most.

Question	Answer
Form Name	Snap Application Form
Form Length	12 pages
Fillable?	Yes
Fillable fields	473
Avg. time to fill out	32 min 33 sec
Other names	application food form, snap recertification food, snap recertification, snap do apply

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LDSS-4826 (REV. 2/18)

NEW YORK STATE OFFICE OF TEMPORARY AND DISABILITY ASSISTANCE

SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM

(SNAP) APPLICATION/RECERTIFICATION

This application can ONLY be used to apply for SNAP

If you are blind or seriously visually impaired and need this application in an alternative format, you may request one from your social services district. For additional information regarding the types of formats available and how you can request an application in an alternative format, see the instruction book (LDSS-4826A), or www.otda.ny.gov.

If you are blind or seriously visually impaired, would you like to receive written notices in an alternative

format?	____ Yes	____ No
If Yes, check the type of format you would like: ___ Large Print			___ Data CD	___ Audio CD

___ Braille, if you assert that none of the other alternative formats will be equally effective for you.

If you require another accommodation, please contact your social services district.

If you are only applying for SNAP you can use this shorter application. If you would like to apply for other benefits such as Temporary Assistance, Child Care Assistance, Home Energy Assistance or Medicaid please ask for a different application.

When You Are Applying For SNAP

•You can file an application the same day you receive it. We must accept your application if, at a minimum, it contains your name, address, (if you have one), and a signature. This information will establish your application filing date.

•You must complete the application process, including having an interview and signing the certification statement on page 8 of the application/recertification for your eligibility to be determined. If you are eligible, benefits will be provided back to the date you filed your application.

•You can apply for and get SNAP for eligible household member(s) even if you or some other members of your household are not eligible for benefits because of immigration status. For example, ineligible alien parents can apply for SNAP for their children and receive benefits for their eligible children.

•You can still apply and be eligible for SNAP even if you have reached your Temporary Assistance time limits.

LDSS-4826 (REV. 2/18)

Page 1

Need SNAP Benefits Right Away? You May Be Eligible For Expedited Processing of your SNAP Application:

If your household has little or no income or liquid resources, or if your rent and utility expenses are more than your income and liquid resources, or you are a migrant or seasonal farmworker with little or no income or resources when you apply, you may be eligible to get SNAP within 5 calendar days of the date you apply. When a resident of an institution is jointly applying for SSI and SNAP prior to leaving the institution, the recorded filing date of the application is the date of release of the applicant from the institution.

Where You Can Apply For SNAP

If you live outside of New York City, you can apply on-line at myBenefits.ny.gov, or call or visit the social services district in the county where you live and ask for an application package, which can be mailed or dropped off to that appropriate office. You can get the address and phone number of the social services district in your county by calling toll free 1-

800-342-3009.

If you live in New York City and you are not also applying for Temporary Assistance, you can apply on-line at myBenefits.ny.gov, or call or visit any SNAP Office and ask for an application package. You can get the address and phone number by calling 1-718-557-1399 or toll free 1-800-342-3009.

Having Problems Coming To Us For A SNAP Interview Appointment?

If it is difficult for you to come in for a SNAP interview appointment (reasons may include employment, health issues, transportation or child care problems), in some circumstances; we can interview you by telephone, or you may have someone else apply for you. Please contact your social services district if you have any questions, to see if you are eligible for a telephone interview, or if you need to reschedule an interview.

NON-DISCRIMINATION NOTICE – In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, sex, religious creed, disability, age, political beliefs, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA.

Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audio tape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.

To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, (AD-3027) found online at: http://www.ascr.usda.gov/complaint_filing_cust.html, and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-

9992. Submit your completed form or letter to USDA by:

(1)mail: U.S. Department of Agriculture

Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410;

(2)fax: (202) 690-7442; or

(3)email: program.intake@usda.gov.

This institution is an equal opportunity provider.

LDSS-4826 (REV. 2/18)

Page 2

NEW YORK STATE OFFICE OF TEMPORARY AND DISABILITY ASSISTANCE

SNAP APPLICATION / RECERTIFICATION

Application Date

Interview Date

Center/Office

Unit

Worker

Case Type Case Number

Registry Number

Version

฀Apply ฀ Recertify

Lang

Legal Name: _______________________________________________ Telephone Number: __________________________ Other phone where you can be reached:	________________________
Residence Address: __________________________________________________________________________ Apt.# ____ City ___________________________, NY	Zip Code ________________

Mailing Address (if different) ____________________________________________________________________ Apt.# ____ City ___________________________, NY Zip Code1________________

Known by Any Other Name: ________________________________ Are You: ฀Applying or	฀Recertifying	Do you want to receive notices in:	฀Spanish and English or ฀English Only


We must accept your application if, at a minimum, it contains your name,	APPLICANT/REPRESENTATIVE SIGNATURE		2	DATE SIGNED
address (if you have one), and signature in this box.			2

List everyone who lives with you even if they are not applying. List yourself first.

Sex

Do you buy

and/

Hispanic

Enter Y (Yes) or N (No) for each

Social Security Number

Is this person

Relationship

or prepare

race*

Marital

applying?

First Name

Last Name

(SSN) of applying member

Date of Birth

to you

food with this

Latino?

(Codes Defined Below)

(If none, write “NONE”)

Status

person?

YES



self



*Race/Ethnic Codes: I – Native American or Alaskan Native, A - Asian,

B – Black or African American,

P – Native Hawaiian or Pacific Islander,

W – White

The provision of this information is voluntary. It will not affect the eligibility of the persons applying or the level of benefits received. The reason for this information is to ensure that program benefits are

distributed without regard to race, color or national origin.

Are you and is everyone living with you a US citizen?

Yes

No If No, who is not a citizen?

Are you or is anyone in your household applying for or receiving SNAP or Temporary Assistance in another place?

Yes

Are you or is anyone living with you a veteran?

Yes

If Yes, who

Do you or does anyone live in a drug or alcohol treatment center, State-certified group living facility or State-certified supervised/supportive apartment?

Yes

If you are recertifying for SNAP, list on Page 9 what has changed since your last application or recertification (such as moved, had a baby, someone moved in or out of your household).

You may use page 9 if you need more room or there is other information that you think we might need.

Go to Page 3

LDSS-4826 (REV. 2/18)

Page 3

INCOME

List ALL your income and the income of everyone living with you. This includes, but is not limited to wages, income from self-employment minus the cost of producing self-employment (for example: babysitting, cleaning, income from a roomer or boarder), child support, pensions, veteran’s benefits, disability, social security or SSI, grants or scholarships for rent or food, Temporary Assistance, and income from friends or relatives.

Name of Person Receiving Income

Source of Income

Hours Worked Per Month

How Often is it Received?

(for example, weekly, bi-weekly,

monthly)

Gross Amount Received

Before Deductions

Do you or does anyone living with you have child/dependent care costs related to employment or training?						Yes	No If Yes, who
Amount paid $ ____________. How often paid (e.g., weekly, monthly) _________________________.
Have you or has anyone living with you changed or quit jobs or reduced any form of income in the last 30 days – including reduced work hours or income?								Yes
Do you or does anyone living with you have any potential income that has not yet been received?					Yes	No	If Yes, explain on Page 9.
Are you or is anyone living with you participating in a strike?	Yes	No	If Yes, who _________________________________________________________ .
Are you or is anyone living with you a boarder, foster child, or foster adult?			Yes	No
If Yes, check B for boarder or F for foster and write their name.		B	F	Name:

No5

RESOURCES

Resources do not affect the eligibility of most households applying for SNAP. However, some resource information is used to determine if you qualify for expedited processing of your application.

How much money does everyone in your household have? (For example, on your person; in your home, in checking and savings accounts, or other locations, including jointly held accounts)


$______________ Belongs to					.
Other financial assets? (For example, stocks, bonds, retirement accounts, savings bonds, mutual funds, IRAs, trust funds, money market certificates) ฀Yes							฀No
If Yes, amount $_______________ Type ________________________________ Owner _________________________________.
How many cars, trucks or other vehicles do you or anyone in your household have?							6
___ #1 Year _____	Make _______________________ Model ________________________ Owner _________________________						6
___ #2 Year _____	Make _______________________ Model ________________________ Owner _________________________
Do you or anyone applying own any property including your own home?		Yes	No	If yes, list property_______________________________ Owner ________________________
Has anyone applying sold, given away or transferred cash or property in the last three months to qualify for SNAP?					Yes	No

How to Edit Snap Application Form Online for Free

It won't be a challenge to fill out application food form working with our PDF editor. This is how you can easily successfully build your file.

Step 1: Step one is to click the orange "Get Form Now" button.

Step 2: Now you may edit the application food form. Feel free to use our multifunctional toolbar to insert, eliminate, and alter the content of the form.

Prepare the application food form PDF and enter the content for every single area:

Include the essential data in the mail, US, Department, of, Agriculture fax, or and email, program, in, take, usda, gov segment.

step 2 to entering details in snap recertification

In the Application, Date Interview, Date Center, Office SNAP, APPLICATION, RECERTIFICATION, Unit Case, Number Case, Type Worker, Registry, Number Version, Apply, Re, certify Lang, APPLICANT, REPRESENTATIVE, SIGNATURE DATE, SIGNED Is, this, person and applying, Relationship section, focus on the significant data.

step 3 to completing snap recertification

Inside the paragraph Yes, No No, If, No, who, is, not, a, citizen No, If, Yes, who Yes, Yes, Yes, Yes, and Goto, Page include the rights and responsibilities of the sides.

Look at the sections for, example, weekly, biweekly monthly, Before, Deductions Yes, No, If, Yes, explain, on, Page No, If, Yes, who F, Name Yes, Yes, Yes, Yes, No, If, Yes, who and RESOURCES and next fill them out.

step 5 to finishing snap recertification

Step 3: Select the Done button to save the file. At this point it is ready for transfer to your gadget.

Step 4: It can be safer to have copies of your form. There is no doubt that we are not going to share or read your data.

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