LDSS-4826: New York SNAP Application/Recertification

When you are applying for SNAP, you can file an application the same day you receive it. Your application must be accepted 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 7 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.

Enter any other name in Known by Any Other Name; mark Applying or Recertifying; and mark if you want to receive notices in Spanish and English or English Only.

Sign in the box for APPLICANT/REPRESENTATIVE SIGNATURE and enter the DATE SIGNED.

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

Anyone applying for SNAP must provide a SSN. If you or anyone applying/recertifying does not have a SSN, a SSN must be applied for with the Social Security Administration (SSA.gov).

Mark Yes or No: are you and is everyone living with you a U.S. citizen? If No, write who is not a citizen.

Mark Yes or No: are you or is anyone living with you a veteran? If Yes, write who. Mark Yes or No: do you or does anyone live in a drug or alcohol treatment center, State-certified group living facility or State-certified supervised/supportive apartment? 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).

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.

Mark Yes or No: do you or does anyone living with you have any potential income that has not yet been received? If Yes, explain on Page 9.

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.

Enter the name of each applying person in the household aged 16 or older, including yourself. For each person, put an "X" in the box in the "Highest Level of Education" section, using the education and training codes shown on the form. Check only one box per person.

The provision of information regarding highest level of education, highest school grade and primary language spoken is voluntary.

Check all the descriptions listed on the form that apply to your household.

Mark Yes or No: are you, and/or anyone living with you, disabled or at least age 60? If yes, write who. If the person has medical bills, list on page 9 what they are for, how much and who is responsible for payment.

You can authorize someone who knows your household circumstances to apply for SNAP for you. If you would like to authorize someone, you must do so in writing. You may do so by printing the person's name, address and phone number.

You can also authorize someone outside your household to get an authorized representative EBT card to buy food for you. Check the box if you want your authorized representative to get an EBT card to buy food for you.

When an Authorized Representative is applying on behalf of a SNAP household that does not reside in an institution, both the Authorized Representative and a responsible adult member of the SNAP household must sign and date the signature sections, unless the Authorized Representative has been otherwise designated by the household in writing.

Any information you provide in connection with your application for SNAP will be subject to verification by Federal, State and local officials. If any information is incorrect, you may be denied SNAP. You may be subject to criminal prosecution if you knowingly provide incorrect information which affects eligibility or the amount of benefits.

CERTIFICATION: You have read and understand the notices; you understand and agree to the terms, authorizations and consents.

You swear and/or affirm under the penalties of perjury that the information you have given or will give to the local Social Services district is correct.

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

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 to or dropped off at that appropriate office.

If you live in New York City and you are not also applying for Temporary Assistance, you can apply on-line at https://www.nyc.gov/hra, or call or visit any SNAP Office and ask for an application package.

SNAP interviews are usually done over the telephone. If you prefer an in-office interview, you must request one from your social services district.

If you are recertifying for SNAP, you must submit the signed recertification application before the interview. If you miss the interview it is your responsibility to contact the social services district to reschedule.

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 7 calendar days of the date you apply.

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

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 non-citizen parents can apply for SNAP for their children and receive benefits for their eligible children.

For SNAP, citizenship must be documented only if questionable.

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.

You can use the VOTER REGISTRATION APPLICATION to: register to vote in New York State; change your name and/or address, if there is a change since you last voted; enroll in a political party or change your enrollment; pre-register to vote if you are 16 or 17 years of age.

This application can only be used to apply or recertify for SNAP. If you would like to apply for other benefits such as Temporary Assistance, Child Care Assistance, Home Energy Assistance or Medicaid, ask for a different application.