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Application For Assistance (Snap Application Form) - Maryland Department Of Human Resources Family Investment Administration Page 10

YOUR RIGHTS AND RESPONSIBILITIES

YOU HAVE THE FOLLOWING RESPONSIBILITIES

PROVIDE INFORMATION – You must give true and complete information. You may need to give

us proof of this information. We will keep this information private. Any delay in providing proof may

result in your case being delayed or denied.

Collecting application information, including the social security number of each household member,

is authorized under the Food and Nutrition Act of 2008, U.S.C.2011-2036, Social Security Act

§1137(f) and 42 U.S.C. §1320b-7(d). We use the information to find out if your household is eligible.

We check this information by matching computer programs.

We also use the information to see if you meet program rules. We may contact your employer, bank

or other party. We may also contact local, state or federal agencies to make sure the information is

correct. We can give your information to other federal or State agencies for official use and to law

enforcement officers who need it to find persons fleeing to avoid the law.

If you get too much in benefits:

You may have to repay the money for the benefits, and

We may give the application information, including social security numbers, to federal or state

agencies, as well as private claims collections agencies, for action.

Giving information is voluntary. If you do not give us information such as social security numbers for

everyone who wants help, we may deny benefits for each person who does not give a social security

number. If you do not have a social security number, we will help you get one.

REPORT CHANGES - You must report all changes within ten days unless you are part of the Food

Supplement Program simplified reporting group and are not receiving Cash Assistance or Medical

Assistance. If you want to know if you are part of this group, ask your case manager. You may tell us

about any changes in person, by telephone, or by mail to the Department.

Warning – We may deny, lower or stop your benefits if you give us wrong information or do

not report changes. A judge may fine and/or imprison you if you deliberately give wrong

information or do not report changes.

AUTHORIZED REPRESENTATIVES – In most instances, if your authorized representative gives us

wrong information, you will have to pay back any amount you are overpaid.

If your authorized representative knowingly gives us the wrong information or does not use your

benefits properly, we may disqualify the person from being an authorized representative.

If a drug and alcohol treatment center or a group living arrangement acts as your authorized

representative for your food benefits and they willfully give us wrong information about your situation,

we may prosecute the person under applicable State or federal law.

DHR/FIA CARES 9701 Revised 9/09

Application For Assistance (Snap Application Form) - Maryland Department Of Human Resources Family Investment Administration Page 10