offered by
Department of Transitional Assistance
related to
About the Department of Transitional Assistance
SNAP benefits (formerly known as food stamps)

Department of Transitional Assistance documents and forms

Below are commonly requested documents and forms for programs offered by the Department of Transitional Assistance.

Please note that some forms - like SNAP Recertification Forms - are pre-filled and mailed to you. If you need to request another Recertification Form, you can check your document history on the DTA Connect web portal or mobile application, or call the DTA Assistance Line at (877) 382-2363.

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Table of Contents

SNAP documents & forms

(Arabic) SNAP معاملة تقديم على فوائد برنامج المساعدات الغذائية التكميلية (DOCX 223.23 KB)
(Chinese) SNAP 福利申请表 (DOCX 112.41 KB)
(English) SNAP benefits application (PDF 690.76 KB)
(English) SNAP benefits application (DOCX 230.72 KB)
(French) Demande d’allocation SNAP (DOCX 124.97 KB)
(Haitian Creole) Aplikasyon pou Avantaj SNAP (DOCX 126.38 KB)
(Italian) Richiesta di prestazioni SNAP (DOCX 159.11 KB)
(Khmer) SNAP Benefits Application (DOCX 146.61 KB)
(Korean) SNAP 혜택 신청서 (DOCX 127.34 KB)
(Polish) Wniosek o świadczenia SNAP (DOCX 154.35 KB)
(Portuguese) Pedido de Benefícios do SNAP (PDF 622.51 KB)
(Portuguese) Pedido de Benefícios do SNAP (DOCX 229.85 KB)
(Russian) Заявление на получение пособия по программе SNAP (DOCX 159.88 KB)
(Spanish) Solicitud de beneficios de SNAP (PDF 709.58 KB)
(Spanish) Solicitud de beneficios de SNAP (DOCX 228.75 KB)
(Vietnamese) Đơn Xin Trợ Cấp SNAP (DOCX 172.22 KB)
(Arabic) نموذج طلب SNAP لكبار السنّ (DOCX 141.53 KB)
(Chinese) 补充营养援助计划（SNAP）年长者申请表 (DOCX 166.71 KB)
(English) SNAP Application for Seniors (PDF 385.08 KB)
(English) SNAP Application for Seniors (DOCX 98.54 KB)
(French) Demande d'allocation SNAP par une personne âgée (DOCX 96.58 KB)
(Haitian Creole) Aplikasyon SNAP pou granmoun (DOCX 91.42 KB)
(Italian) Richiesta di sussidi alimentari SNAP per anziani (DOCX 104.51 KB)
(Khmer) ពាក្យសុំ SNAP សំរាប់ព្រឹទ្ធាវ័យ (DOCX 125.91 KB)
(Korean) 노인 SNAP 신청서 (DOCX 107.19 KB)
(Polish) Wniosek o SNAP dla osób starszych (DOCX 94.21 KB)
(Portuguese) Formulário de inscrição de idosos no SNAP (PDF 456.01 KB)
(Portuguese) Formulário de inscrição de idosos no SNAP (DOCX 88.39 KB)
(Russian) Форма заявления на участие в программе SNAP для пожилых людей (DOCX 100.08 KB)
(Spanish) SNAP Solicitud para personas mayores (PDF 378.03 KB)
(Spanish) SNAP Solicitud para personas mayores (DOCX 86.35 KB)
(Vietnamese) Đơn Xin SNAP dành cho Người Cao Niên (DOCX 91.01 KB)
SNAP work requirement medical report (DOCX 46.56 KB)
Community College Verification Form (CCE-1) (DOCX 45.06 KB)
(English) DTA cover sheet (DOCX 102.4 KB)
(English) DTA cover sheet (PDF 61.98 KB)
(Spanish) Hoja de portada de correo/fax para Manejo electrónico de documentos (EDM) del Departamento de Asistencia Transitoria (DTA) (DTA cover sheet) (DOCX 101.88 KB)
(Spanish) Hoja de portada de correo/fax para Manejo electrónico de documentos (EDM) del Departamento de Asistencia Transitoria (DTA) (DTA cover sheet) (PDF 62.3 KB)
Educational Income and Expense Form (EDUC-1) (DOCX 35.24 KB)
Request to Choose Someone to Be My Authorized Representative (Image-10) (DOCX 31.71 KB)
Solicitud para elegir a alguien que sea mi representante autorizado (Image-10) (DOCX 44.44 KB)
(English) Request for Agency Employee(s) to be my SNAP Authorized Representative (Image-10a) (DOCX 93.15 KB)
(Spanish) Solicitud para que un Empleado de la Agencia sea mi Representante autorizado ante SNAP (Image-10a) (DOCX 92.34 KB)
(English) SNAP medical expenses brochure (PDF 198.14 KB)
(English) SNAP Medical expenses brochure (DOCX 154.53 KB)
(Portuguese) Solicitar a dedução de despesas médicas e comprová-las pode aumentar o valor de seus benefícios do SNAP (SNAP-MEB) (PDF 206.24 KB)
(Portuguese) Solicitar a dedução de despesas médicas e comprová-las pode aumentar o valor de seus benefícios do SNAP (SNAP-MEB (DOCX 155.47 KB)
(Spanish) El reclamo y la verificación de gastos médicos pueden aumentar sus beneficios de SNAP (SNAP-MEB) (PDF 194.18 KB)
(Spanish) El reclamo y la verificación de gastos médicos pueden aumentar sus beneficios de SNAP (SNAP-MEB) (DOCX 148.91 KB)
Other Agency Certification of Shelter and Utility Costs (FS-ACSE) (DOCX 51.58 KB)
Voluntary Consent to Release Information (DOCX 20.21 KB)
(Spanish) Consentimiento voluntario para divulgar información (DOCX 19.36 KB)
(English) Request for Replacement SNAP Benefits Due to Household Disaster or Misfortune for Massachusetts Residents (SNAP-9B) (PDF 244.93 KB)
(Spanish) Solicitud de reemplazo de beneficios de SNAP debido a un desastre o infortunio en el hogar de Residentes de Massachusetts (SNAP-9B) (PDF 198.87 KB)
(English) Request for Replacement SNAP Benefits Due to Household Disaster or Misfortune for Massachusetts Residents (SNAP-9B) (DOCX 40.15 KB)
(Spanish) Solicitud de reemplazo de beneficios de SNAP debido a un desastre o infortunio en el hogar de Residentes de Massachusetts (SNAP-9B) (DOCX 51.98 KB)
(English) Permission to Share Information Form (PDF 32.67 KB)
(Spanish) Formulario de autorización para compartir información (PDF 52.16 KB)

Economic Assistance (cash benefits) documents & forms

(English) Authorization for reimbursement of interim assistance Initial claim or posteligibility case (AP-SSI-IAR) (DOCX 18.94 KB)
(Spanish) Autorización para el reembolso de asistencia temporal reclamo inicial o caso de post elegibilidad (AP-SSI-IAR) (DOCX 19.13 KB)
Direct Deposit Form (CA/DD) (DOCX 91.23 KB)
(English) DTA cover sheet (DOCX 102.4 KB)
(English) Department of Transitional Assistance Emergency Aid to the Elderly, Disabled and Children Disability Supplement (EAEDC-DS) (DOCX 59.67 KB)
(Spanish) Departamento de asistencia transitoria Asistencia de emergencia para personas de la tercera edad, incapacitados y niños Suplemento de incapacidad (EAEDC-DS) (DOCX 69.4 KB)
Massachusetts Department of Transitional Assistance EAEDC Medical Report (EAEDC-Med Rpt) (DOCX 55.25 KB)
Educational Income and Expense Form (EDUC-1) (DOCX 35.24 KB)
Good Cause Medical Statement (TAFDC‐GCMS) (DOCX 29.24 KB)
(English) Department of Transitional Assistance transitional aid to families with dependent children disability supplement (TAFDC-DS) (DOCX 59.18 KB)
(Spanish) Departamento de asistencia transitoria Asistencia transitoria para familias con hijos dependientes Suplemento de incapacidad (TAFDC-DS) (DOCX 68.42 KB)
SNAP Disability Verification for Elderly Noncitizens (SNAP-DVEN) (English & Spanish) (DOCX 34.39 KB)
Verification of Caring for the Disabled (TAFDC-4) (DOCX 35.41 KB)
Voluntary Consent to Release Information (DOCX 20.21 KB)
(Spanish) Consentimiento voluntario para divulgar información (DOCX 19.36 KB)
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