Fillable California Food Stamp Application (Page 2 of 5) in pdf

Applying For Food Stamp Benefits

Useful Tips and Information

Please read the following—there is nothing to fill out on this page.

WHAT WE MEAN WHEN WE SAY

To help you understand some of the words used in the application and the interview, refer to the definitions below.

You, Anyone, Everyone — Any and all persons who live in

Income — Money received or expected to receive this month,

your home and who are applying for food stamp benefits.

such as:

When we need information about the other people in your

•

Earnings, welfare, child support, SSI or Social Security, or

home, we will ask you.

veterans payments

Your Household — People living in the home who buy and

•

Pension or retirement payments

prepare food together and are applying for food stamp

•

Unemployment (UIB), State Disability (SDI) or other

benefits.

disability

Food Stamp Benefits — Benefits for low-income households

•

Strike funds, payments from roomers, school grants and

to help buy food.

loans

Food Stamps Expedited Service — Food stamp benefits

•

Cash gifts, cash winnings, or any other cash payments

available to you within three (3) days.

Resources — Money you have, such as:

Cash Aid — California Work Opportunity and Responsibility to

•

Kids (CalWORKs), Refugee Assistance, or your county’s local

Cash on hand, uncashed checks, money in checking

accounts, savings accounts, or savings certificates, etc.

Cash Aid program [General Assistance or General Relief

•

(GA/GR), or Cash Assistance Program for Immigrants (CAPI)].

Trust deeds, notes receivable, stocks or bonds, etc.

Utilities — Gas, electricity, heating, fuel, telephone (basic rate),

utility installation, garbage and trash pickup, water, sewage, etc.

OTHER THINGS YOU SHOULD KNOW

COMPLAINTS AND STATE HEARINGS

•

If you have a complaint, try to work it out with the

You may wonder why we ask some of the questions. All

county. If you can’t work it out, you may call or write to:

questions are required by Federal/State law to determine

your eligibility for food stamp benefits.

California Department of Social Services

•

744 P Street, MS 8-16-50

You can apply for food stamp benefits and cash aid at the same

Sacramento, CA 95814

time and have only one interview for both, except when you

Phone Number: 1-800-952-5253,

apply for GA/GR as a cash aid.

or for the hearing or speech impaired call

•

If your food stamp benefits, Authorization Document (AD) or

1-800-952-8349

issuance cards are lost in the mail, you must report it before the

If you think any action taken by the County is wrong, you

end of the month in which you should have gotten them. But if

can ask for a State Hearing by writing to your local

they were stolen or destroyed, you must report your loss within

county welfare office or by calling the phone numbers

ten (10) days of the incident.

listed above. You must ask for a hearing within ninety (90)

•

If you receive too many food stamp benefits, you will have to pay

days of the action and tell why you want one.

them back and/or your benefits may be lowered or stopped. Your

The law says that all applicants/recipients for aid,

Social Security Number (SSN) may be used to collect the amount

benefits or services are to be treated fairly without

of benefits owed, through the courts, other collection agencies

regard to race, color, national origin, political affiliation,

and for federal government collection action.

religion, marital status, sex, age or disability.

•

Your SSN will be used to check identity to prevent duplicate

If you think you have been discriminated against, you

participation and to verify eligibility and benefits. The SSN will be

may file a complaint by:

used in computer matches to check your income and resources

1. Contacting your county’s civil rights coordinator; or

with records from tax, welfare, employment, the Social Security

Administration and other agencies. Differences may be checked

2. Writing to or calling:

out with you and with employers, banks, or others. Fraudulent

The state’s Civil Rights Bureau, M.S. 8-16-70,

participation in the Food Stamp Program may result in criminal or

P.O. Box 944243, Sacramento, CA 94244-2430

civil action or administrative claims.

1-866-741-6241 (Toll Free)

•

Providing your SSN is not required when you first submit your

3. Or for Food Stamp benefits only, writing to:

application. However, you will be asked to give us information to

Secretary of Agriculture

figure the eligibility and benefits for other members of your

U.S. Department of Agriculture

household.You usually have to give us your SSN(s) or proof of

14th & Independence Avenue, S.W.

application for your SSN(s) before we can give you any benefits.

Room 200A

We can deny you or any member of your household benefits for

Administration Building

failure to provide an SSN.

Washington, D.C. 20250

DFA 285 A1 (4/09)

California Food Stamp Application Page 2

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