Table of Contents for the resource, DTA Documents & Forms

• SNAP Benefits
  • SNAP Benefits Applications 
  • SNAP Benefits Applications for Seniors 
  • SNAP Work Requirement Medical Report (FSPWR-WP-MED) 
  • Request to Choose Someone to Be My Authorized Representative 
  • Other Agency Certification of Shelter and Utility Costs 
  • SNAP-9B - Request for Replacement SNAP Benefits 
  • Permission to Share Information Form (PSI) 
  • Out-of-Pocket Medical Expenses Form 
• Economic Assistance (cash benefits)
  • Application for Funeral and Final Disposition Benefit 
  • Authorization for reimbursement of interim assistance Initial claim or posteligibility case 
  • Direct Deposit form 
  • EAEDC Medical Provider Statement 
  • Good Cause Medical Statement 
  • High School Equivalency (HSE) Test Voucher Request 
  • Verification of Caring for the Disabled 
• Across Programs
  • Client Feedback Form 
  • DTA Mail/Fax Cover Sheet 
  • Voluntary Consent to Release Information 
• Outreach Materials (flyers, social media)
  • SNAP Outreach Flyers 
  • EBT Brochures 
  • HIP Outreach Materials 
  • Protect Your EBT Benefits Outreach Materials 
  • SNAP Medical Expense Flyer 
  • DTA Connect Outreach Materials