SI NY01801.105 (New York) The Food Stamp Application (LDSS-4826) (RTS # 407 -- 03/2007)
LDSS-4826 – “Food Stamp Benefits Application/ Recertification” is the New York application for all categorically eligible food stamp applicants and beneficiaries. It should be used by FO employees when taking food stamp applications for those in a pure food stamp household. It is a self explanatory form.
The LDSS-2921 - Application for Temporary Assistance - Medical Assistance - Medicare Savings Program - Food Stamp Benefits - Services - including Foster Care - Child Care Assistance is a general New York form and should be placed in the reception area with other food stamp information.
After completing a food stamp application for an SSI applicant/recipient (who resides in a pure SSI household per POMS SI 01801.005), the application and all available documentation should be forwarded to the servicing food stamp office, within one workday after the day the application is taken.
The FO will mail the material using the SSA-4233 "Social Security Administration Transmittal for Food Stamp Applications" (per POMS SI 01801.400.) SSA interviewers will also advise the applicants that they will have to provide whatever documentation is needed by the food stamp office.
Field Offices should make clear that any further follow-up contacts for food stamps must be made with the food stamp office and that the proofs required by SSA must be submitted to SSA separately. The SSA interviewer will give the applicant a self-addressed envelope, to the food stamp office, in which the verification required, should be mailed directly to the food stamp office.
B. Mailing the Applications
After completing the food stamp application, the SSA interviewer will mail the food stamp application, the completed SSA-4233 "Social Security Transmittal for Food Stamp Applications" and all other evidence to the local food stamp office.
1. New York State (Outside of New York City)
Offices should mail the completed forms to the local food stamp office in the county where the applicant resides.
2. New York City
Pure SSI Household
New York City has established one center in the City to handle the majority of food stamp applications/recertifications. This office processes food stamp applications/recertifications where the SSI household has one or two members. (If there are more than two members in the SSI household, the application/recertification should be sent to the Food Stamp Center servicing the householder's zip code.)
Any applications taken in New York City, where the SSI household has one or two members, should be mailed to:
Food Stamp Program (Center F15)
233 Schermerhorn St.
Brooklyn, New York 11202.
The general telephone number is: 718-722-4009.
C. Ordering Applications
NY State: Contact the local Department of Social Service or the New York State Office of Temporary and Disability Assistance (OTDA).
Phone: (518) 486-6302 and FAX (518) 402-0084.
NY City: Contact the New York Regional Office - Center for Programs Support (CPS) at (212) 264-4009.
When requesting additional food stamp applications, you must include the mailing address of the office, the number of applications needed, and the name and telephone number of a contact person.
Applicants/recipients who would like additional information on food stamps can call the toll-free New York State Temporary and Disability Assistance Hotline at 1-800-342-3009.