Food (Snap) And Cash Assistance Combined Application (Page 4 of 5) in pdf

YOUR RESPONSIBILITIES (CONTINUED)

page 4 01/09

CHANGES MUST BE REPORTED WITHIN 10 DAYS of the household’s knowledge of change: Your

CHANGES MUST BE REPORTED WITHIN 10 DAYS of the household’s knowledge of change: Your SNAP a a a a l l l l l l l l o o o o t t t t m m m m e e e e n n n n t t t t w w w w i i i i l l l l l l l l n n n n o o o o t t t t n n n n e e e e c c c c e e e e s s s s s s s s a a a a r r r r i i i i l l l l y y y y b b b b e e e e r r r r e e e e d d d d u u u u c c c c e e e e d d d d o o o o r r r r

•

terminated when you report a cha

terminated when you report a change. It may increase

nge. It may increase

nge. It may increase. . . . If your household is assigned to

If your household is assigned to

If your household is assigned to Simplified Reporting

If your household is assigned to

Simplified Reporting

Simplified Reporting, you must let the

, you must let the

, you must let the SNAP

SNAP

SNAP C C C C e e e e r r r r t t t t i i i i f f f f i i i i c c c c a a a a t t t t i i i i o o o o n n n n O O O O f f f f f f f f i i i i c c c c e e e e

SNAP

know when your family’s income exceeds the monthly income allowed for yo

know when your family’s income exceeds the monthly income allowed for your

ur ur

ur household size. You must report this change by the 10

household size. You must report this change by the 10

th th th th

day y y y o o o o f f f f t t t t h h h h e e e e n n n n e e e e x x x x t t t t

month.

I understand that if my application is for

I understand that if my application is for SNAP, , , , f f f f a a a a i i i i l l l l u u u u r r r r e e e e t t t t o o o o r r r r e e e e p p p p o o o o r r r r t t t t o o o o r r r r v v v v e e e e r r r r i i i i f f f f y y y y a a a a n n n n y y y y o o o o f f f f m m m m y y y y e e e e x x x x p p p p e e e e n n n n s s s s e e e e s s s s w w w w i i i i l l l l l l l l b b b b e e e e s s s s e e e e e e e e n n n n a a a a s s s s a a a a s s s s t t t t a a a a t t t t e e e e m m m m e e e e n n n n t t t t b b b b y y y y m m m m y y y y h h h h o o o o u u u u s s s s e e e e h h h h o o o o l l l l d d d d t t t t h h h h a a a a t t t t I I I I d d d d o o o o n n n n o o o o t t t t w w w w a a a a n n n n t t t t

•

to receive a deduction for unreported

to receive a deduction for unreported expenses

expenses

expenses. . . .

You

You are authorized to

are authorized to rec

receive “The Smart Family Brochure

eive “The Smart Family Brochure. . . . ” ” ” ” T T T T his brochure provides

his brochure provides information on

information on families making good decisions.

families making good decisions.

You

are authorized to

rec

eive “The Smart Family Brochure

his brochure provides

information on

families making good decisions.

•

The State or Federal Quality Control Agency may randomly choose your case for review. They will review statements you have

The State or Federal Quality Control Agency may randomly choose your case for review. They will review statements you have m m m m a a a a d d d d e e e e o o o o n n n n y y y y o o o o u u u u r r r r a a a a p p p p p p p p l l l l i i i i c c c c a a a a t t t t i i i i o o o o n n n n . . . .

•

They will check to see if we figured your eligibility correct.

The state agency may seek information from other sources. T

The state agency may seek information from other sources. Th h h h e e e e S S S S t t t t a a a a t t t t e e e e o o o o r r r r F F F F e e e e d d d d e e e e r r r r a a a a l l l l Q Q Q Q u u u u a a a a l l l l i i i i t t t t y y y y

Control agency will tell you about any contact they intend to make. IF YOU DO NOT COOPERATE, YOUR B

Control agency will tell you about any contact they intend to make. IF YOU DO NOT COOPERATE, YOUR BENEFITS MAY STOP.

ENEFITS MAY STOP.

CONTACT YOUR WORKER IF YOU HAVE ANY QUESTIONS OR ARE UNSURE ABOUT ANY REPORTING RULES.

•

PENALTY WARNING

If a

If any information you give is found to be incorrect, you may be denied

If a

ny information you give is found to be incorrect, you may be denied

ny information you give is found to be incorrect, you may be denied SNAP

ny information you give is found to be incorrect, you may be denied

SNAP

SNAP/ / / / cash benefits

cash benefits

cash benefits. If you give us false information on purp

. If you give us false information on purp

. If you give us false information on purpo o o o s s s s e e e e l l l l e e e e g g g g a a a a l l l l a a a a c c c c t t t t i i i i o o o o n n n n m m m m a a a a y y y y b b b b e e e e t t t t a a a a k k k k e e e e n n n n a a a a g g g g a a a a i i i i n n n n s s s s t t t t

. If you give us false information on purp

you. You may also have to pay back the amount of benefits that you should not have received.

If you get

If you get SNAP

If you get

SNAP

SNAP, you must follow the rules listed below.

SNAP

, you must follow the rules listed below.

, you must follow the rules listed below. Any member of your household who is found guilty by a court or

Any member of your household who is found guilty by a court or

Any member of your household who is found guilty by a court or a a a a n n n n a a a a d d d d m m m m i i i i n n n n i i i i s s s s t t t t r r r r a a a a t t t t i i i i v v v v e e e e d d d d i i i i s s s s q q q q u u u u a a a a l l l l i i i i f f f f i i i i c c c c a a a a t t t t i i i i o o o o n n n n h h h h e e e e a a a a r r r r i i i i n n n n g g g g o o o o f f f f

Any member of your household who is found guilty by a court or

breaking any of the following rules or who signs a voluntary disqualification consent agreement or waiver of an administratio

breaking any of the following rules or who signs a voluntary disqualification consent agreement or waiver of an administration disqualifica

breaking any of the following rules or who signs a voluntary disqualification consent agreement or waiver of an administratio

n disqualifica

n disqualificat t t t i i i i o o o o n n n n h h h h e e e e a a a a r r r r i i i i n n n n g g g g w w w w i i i i l l l l l l l l b b b b e e e e b b b b a a a a r r r r r r r r e e e e d d d d

from

from getting SNAP benefits for: one year fo

from

getting SNAP benefits for: one year fo

getting SNAP benefits for: one year for the first violation, two years for the second violation, and permanently for the third violation.

r the first violation, two years for the second violation, and permanently for the third violation.

D D D D O NOT

O NOT

O NOT give false information or hide information to get or continue to get

give false information or hide information to get or continue to get

give false information or hide information to get or continue to get SNAP

SNAP

SNAP. . . .

•

DO NOT trade

DO NOT

trade, sell

, sell or

or alter

alter your

your SNAP

SNAP or

or authorization cards or any aut

authorization cards or any authorization document.

horization document.

DO NOT

trade

, sell

or or

alter

your

SNAP

or or

authorization cards or any aut

horization document.

•

DO NOT

DO NOT use

DO NOT

use

use SNAP

SNAP

SNAP benefits

SNAP

benefits

benefits to buy ineligible items, such as alcohol

to buy ineligible items, such as alcohol

to buy ineligible items, such as alcohol drinks and

drinks and

drinks and tobacco.

tobacco.

•

DO NOT use someone else’s

DO NOT

use someone else’s SNAP or authorization cards for your

SNAP or authorization cards for your household

household. . . .

DO NOT

use someone else’s

SNAP or authorization cards for your

household

•

DO NOT

DO NOT use your

DO NOT

use your

use your SNAP

SNAP

SNAP card to purchase food on credit.

card to purchase food on credit.

•

Any household member

Any household member found guilty by a court of

Any household member

found guilty by a court of

found guilty by a court of having used SNAP benefits to buy

having used SNAP benefits to buy

having used SNAP benefits to buy i i i i l l l l l l l l e e e e g g g g a a a a l l l l d d d d r r r r u u u u g g g g s s s s w w w w i i i i l l l l l l l l b b b b e e e e d d d d i i i i s s s s q q q q u u u u a a a a l l l l i i i i f f f f i i i i e e e e d d d d f f f f o o o o r r r r : : : : 2 2 2 2 4 4 4 4 m m m m o o o o n n n n t t t t h h h h f f f f o o o o r r r r t t t t h h h h e e e e f f f f i i i i r r r r s s s s t t t t v v v v i i i i o o o o l l l l a a a a t t t t i i i i o o o o n n n n ; ; ; ; a a a a n n n n d d d d p p p p e e e e r r r r m m m m a a a a n n n n e e e e n n n n t t t t l l l l y y y y

having used SNAP benefits to buy

for the

for the second

for the

second

second violation.

violation.

Any member who is found guilty by a

Any

member who is found guilty by a court of

court of using SNAP benefits to buy firear

using SNAP benefits to buy firearm m m m s s s s , , , , a a a a m m m m m m m m u u u u n n n n i i i i t t t t i i i i o o o o n n n n , , , , o o o o r r r r e e e e x x x x p p p p l l l l o o o o s s s s i i i i v v v v e e e e s s s s w w w w i i i i l l l l l l l l b b b b e e e e p p p p e e e e r r r r m m m m a a a a n n n n e e e e n n n n t t t t l l l l y y y y d d d d i i i i s s s s q q q q u u u u a a a a l l l l i i i i f f f f i i i i e e e e d d d d f f f f r r r r o o o o m m m m S S S S N N N N A A A A P P P P o o o o n n n n t t t t h h h h e e e e f f f f i i i i r r r r s s s s t t t t

Any

member who is found guilty by a

court of

using SNAP benefits to buy firear

instance.

Any

Any household member convicted

Any

household member convicted

household member convicted of a felony for distributing or selling controlled substances,

household member convicted

of a felony for distributing or selling controlled substances,

of a felony for distributing or selling controlled substances, will be permanently disqualified from SNAP.

will be permanently disqualified from SNAP.

Any household member convicted by a court of having trafficked SNAP benefits for an aggregate amount o

Any household member

convicted by a court of having trafficked SNAP benefits for an aggregate amount of f f f $500 or more shall be permanently disqualified from SNAP

$500 or more shall be permanently disqualified from SNAP

Any household member

convicted by a court of having trafficked SNAP benefits for an aggregate amount o

$500 or more shall be permanently disqualified from SNAP

upon the first occasion of such violation.

Any household

Any

household member found to have made a fraudulent statement or repre

member found to have made a fraudulent statement or repres s s s e e e e n n n n t t t t a a a a t t t t i i i i o o o o n n n n w w w w i i i i t t t t h h h h r r r r e e e e s s s s p p p p e e e e c c c c t t t t t t t t o o o o t t t t h h h h e e e e i i i i d d d d e e e e n n n n t t t t i i i i t t t t y y y y o o o o r r r r p p p p l l l l a a a a c c c c e e e e o o o o f f f f r r r r e e e e s s s s i i i i d d d d e e e e n n n n c c c c e e e e o o o o f f f f t t t t h h h h e e e e i i i i n n n n d d d d i i i i v v v v i i i i d d d d u u u u a a a a l l l l i i i i n n n n o o o o r r r r d d d d e e e e r r r r t t t t o o o o

Any

household

member found to have made a fraudulent statement or repre

receive multiple SNAP

receive multiple

SNAP benefits simultaneously shall be ineligible to participate in

benefits simultaneously shall be ineligible to participate in SNAP

SNAP for a period of 10 years.

for a period of 10 years.

receive multiple

SNAP

benefits simultaneously shall be ineligible to participate in

SNAP

for a period of 10 years.

Any household member fleeing to avoid prosecution, custody, or confinement

Any household member fleeing to avoid prosecution

, custody, or confinement after conviction

after conviction for a

for a f f f f e e e e l l l l o o o o n n n n y y y y , , , , o o o o r r r r a a a a t t t t t t t t e e e e m m m m p p p p t t t t e e e e d d d d f f f f e e e e l l l l o o o o n n n n y y y y , , , , o o o o r r r r v v v v i i i i o o o o l l l l a a a a t t t t i i i i n n n n g g g g a a a a c c c c o o o o n n n n d d d d i i i i t t t t i i i i o o o o n n n n o o o o f f f f p p p p r r r r o o o o b b b b a a a a t t t t i i i i o o o o n n n n o o o o r r r r

Any household member fleeing to avoid prosecution

, custody, or confinement

after conviction

for a

parole will be ineligible until the situation is rectified.

Any person found guilty of violating these rules or committing fraud may be fined up to $250,000, jailed up to 20 years and/or required to repay SNAP benefits.

Any person found guilty of violating these rules or committing fraud may

be fined up to $250,000, jailed up to 20 years and/or required to repay SNAP benefits.

Any person found guilty of violating these rules or committing fraud may

be fined up to $250,000, jailed up to 20 years and/or required to repay SNAP benefits.

You can also be barred from the TANF Program for the same time period for fraud and the same maximum penalties apply.