Ssi Food Stamp Benefits Reapplication Form printable pdf download

Ssi Food Stamp Benefits Reapplication Form

Massachusetts Department of Transitional Assistance

Instructions for SSI Food Stamp Benefits Reapplication

This is our SSI Food Stamp Benefits Reapplication form. Please answer every

question, read the Food Stamp Penalty warning notice, sign the form and return

the form to your SSI Regional Office.

Your food stamp benefits will end soon. If you wish to continue receiving food stamp

benefits, you must complete and mail this reapplication form to your SSI Regional Office

by the date on the enclosed card. Return the completed reapplication form to

Malden SSI Regional Office

200 Pleasant Street

Malden, MA 02148

If you still want to receive food stamp benefits but do not complete and mail this reapplication

form by the date on your card, there may not be time to process your reapplication. If you

delay too long, you will lose some food stamp benefits. If you have completed the

reapplication form but are awaiting verifications, return the reapplication form and attach a note

saying what verifications are missing. Call the telephone number of your SSI Regional Office if

you need help getting verifications and someone will help you. The call to your office is

toll-free.

Telephone # 1-800-590-4820

All eligible SSI/Food Stamp recipients will receive food stamp benefits through the Electronic

Benefit Transfer (EBT) system. EBT will allow SSI/FS recipients to access their food stamp

benefits at Point-of-Sale terminals in food stores and ensure that your food stamp benefits are

available when due.

Special Instructions for Completing the Reapplication Form

• Answer every question.

• Read the Penalty Warning carefully (page 4).

• On page 1 of the reapplication form put your telephone number where you can be reached

weekdays between 9:00 a.m. and 4:30 p.m., or where a message can be left for you.

• After you have completed the reapplication form, sign the form and return the form to your

SSI Regional Office.

SSI/FSP-1 (Rev. 6/2008)

09-150-0608-05

Ssi Food Stamp Benefits Reapplication Form