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.