Form Dhs-2 - Application Forassistance - Rhode Island Department Of Human Services Page 34
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38DHS-2 Rev. 10-14
Page 30
III. SNAP PENALTY WARNINGS
I understand that:
1. Any member of my household who intentionally breaks a SNAP rule will be barred from the SNAP from one year to permanently,
fined up to $250,000, imprisoned up to 20 years or both. S/he may also be subject to prosecution under other applicable Federal and
State laws. S/he may also be barred from the SNAP for an additional 18 months if court ordered. Any member of my household who
intentionally breaks a SNAP rule can be barred from the Supplemental Nutrition Assistance Program:
*For a period of one (1) year for the first violation, with the exceptions in numbers 2. and 3. below;
*For a period of two (2) years after the second violation, with the exception in number 3. below; and,
*Permanently for the third occasion of any intentional program violation.
2. Individuals found by a Federal, State, or local court to have used or received SNAP benefits in a transaction involving the sale of
firearms, ammunitions or explosives shall be permanently ineligible for the Supplemental Nutrition Assistance Program upon the first
occasion of such violation.
3. Individuals found to have made a fraudulent statement or representation with respect to the identity or place of residence of the
individual in order to receive multiple SNAP benefits simultaneously shall be ineligible to participate in the Supplemental Nutrition
Assistance Program for a period of ten (10) years.
4. Individuals found guilty by a Federal, State or local court of law for using or receiving benefits in a transaction involving the sale of
a controlled substance (as defined in section 102 of the Controlled Substances Act (21 U.S.C. 802)) will not be eligible for benefits for
two years for the first offense, and permanently for the second offense.
5. Individuals found guilty by a court of law for buying or selling illegal drugs or certain prescription drugs in exchange for SNAP
benefits will be prohibited from participating in the SNAP for 24 months for the first offense and permanently for the second offense.
6. An individual convicted by a Federal, State, or local court of having trafficked benefits for an aggregate amount of $500 or more
shall be permanently ineligible to receive SNAP benefits upon the first occasion of such violation.
DO NOT give false information or hide information to get or continue to get SNAP benefits.
DO NOT trade or sell EBT cards.
DO NOT use SNAP benefits to buy ineligible items, such as alcoholic drinks and tobacco.
DO NOT use someone else’s EBT card for your household.
DO NOT pay for food purchased on credit with SNAP benefits. Doing so could result in disqualification from the program.
DHS can use or share information on this application for the administration of DHS programs, as well as the administration of other
federally funded assistance programs in accordance with state and federal law, contract and regulation.
DHS can release non-identifying information for research purposes. Any release of identifying information shall be done in
accordance with state and federal law.
I understand the questions on this application and the penalty for hiding or giving false information or breaking any of the rules listed in
this Penalty Warning.
I certify under penalty of perjury that my answers are correct, including information about citizenship and alien status, and complete to
the best of my knowledge and belief. I know that under the state of Rhode Island General Laws, Section 40-6-15, a maximum fine of
$1,000, or imprisonment of up to five (5) years, or both, may be imposed for a person who obtains or attempts to obtain, or aids or
abets any person to obtain, public assistance to which s/he is not entitled, or who willfully fails to report income, resources or personal
circumstances or increases therein which exceed the amount previously reported. I attest to the identity of the minor children identified
herein and that all of the information contained in this application is true. I understand that I am breaking the law if I give wrong
information and can be punished under federal law, state law or both.
Signature of Applicant or Recipient
Date
Signature of Authorized Representative
Date
Signature of Spouse or other parent of child(ren)
Date
Signature of Person Helping you Complete this Form
Date
Signature of Guardian, Conservator or Holder of
Date
Signature of Agency Representative
Date
Power of Attorney
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