SI BOS01801.300 Application for Food Stamps — Connecticut (TN 5-253 — 07/2005)

A. Introduction

The Food Stamp Act of 1977 requires SSA to take food stamp applications from SSI applicants and SSI recipients who live in pure SSI households. In addition, under the prerelease process, residents of public institutions may apply for food stamps at the same time they file for SSI benefits, if they expect to live in a pure SSI household upon release.

B. Policy

Per SI 01801.060 a pure SSI household is defined as follows:

  • An individual who lives alone and is applying for or receiving SSI, or

  • A household (as defined for food assistance purposes) where everyone has applied for or is receiving SSI.

For food assistance purposes, it is important to remember that more than one household can live under one roof, if separate purchase and preparation of food is declared. If other persons who are not SSI applicants/recipients physically live in the same household with the SSI claimant/recipient and he/she purchases and prepares food separately from the rest of the household, he/she meets the definition of a pure SSI household. For food assistance purposes he/she is considered to be in his/her own household. Do not confuse the living arrangement determination for SSI payment purposes with the living arrangement determination needed for food assistance purposes.

Consider individuals who live in public/private nonprofit shelters for the homeless as individual households for food stamp application purposes. (See SI 01801.040.)

SSA must use State designed food stamp applications. The State of Connecticut Department of Social Services (CT DSS) must provide SSA field offices (FOs) with sufficient food stamp application forms for FO use. The State must also provide SSA with informational material to distribute to food stamp applicants.

C. Procedure

1. Completing the Application

Complete the Connecticut food stamp application for an individual who:

  • Is a Connecticut resident,

  • Is an SSI applicant/recipient,

  • Resides in a pure SSI household as defined for food assistance purposes or is in a public institution and filing for SSI benefits under the pre-release program, and

  • Wishes to apply for food stamps at the SSA FO. Interviewers must encourage members of a pure SSI household to file for food assistance at SSA. Refer to SI 01801.015, if an individual in a pure SSI household is reluctant to file for food stamps in the SSA FO.

There are two food stamp applications available from the CT DSS. For most pure SSI households the five-page “Application for Food Stamp Benefits Only,” the W-1FOOD (Rev. 1/06), is the appropriate form. It can be used for households with up to three members. For larger households use the full “Eligibility Determination Document,” the W-1E (Rev. 5/04).

The shorter form W1-FOOD is covered by a computation sheet for expedited service. Return to this sheet after completing the application, to determine whether expedited service is appropriate. (See SI 01801.150.)

To complete the Application for Food Stamp Benefits Only, the W1-FOOD (Rev. 3/15):

  • Complete the applicant information on the first page of the application form.

  • Complete the remaining questions on the form.

  • Have the applicant sign the first page of the form.

  • Sign your name in the space labeled “Helper's Signature.” Annotate “SSA” next to your signature.

Additional instructions for completing the longer Eligibility Determination Document, the W-1E (Rev. 5/04):

  • Leave the instructions page attached to the application when routing it to the food stamp office. The food stamp office will complete it and send it to the applicant with the CT DSS worker's name.

  • Check the Food Stamp Assistance box on page one to indicate that the individual is applying for food stamps.

  • Do not write in shaded areas. All shaded areas are for the CT DSS caseworker's annotations only.

  • Complete all questions not preceded by an asterisk.

  • Have the applicant sign the last page of the form.

  • Sign your name in the space labeled “Helper's Signature.” Annotate “SSA” next to your signature.

When completing either form:

  • Write the word “PRERELEASE,” if appropriate, in large letters in red ink across the top of the first page of the completed food stamp application.

  • Obtain from the food stamp applicant the documentation needed by the food stamp agency to process the claim. (See SI 01801.300C.)

2. Providing Informational Material to the Applicant

Provide the applicant the CT DSS brochure, “A Guide to the Food Stamp Program,” Publication No. 96-3. This material informs the applicant of the basic eligibility requirements, the 30-day application processing requirement, and the local food stamp office addresses and telephone numbers.

3. Routing the Food Stamp Application

Send the completed food stamp application (using SSA-4233, SSA Transmittal for Food Stamp Applications) to the servicing CT DSS office within one Federal workday after receipt of a signed application. (For instructions see SI 01801.310.) A printer-friendly version of the SSA-4233 is in SI 01801.400.

Write boldly in red ink “Expedited Service” across the top of the SSA-4233 when requesting expedited service.

D. List of Food Stamp Offices

The Connecticut Department of Social Services provides a current list of regional offices on its website.

E. Obtaining Additional Applications and Information Material

The Connecticut Application for Food Stamp Benefits Only (W-1FOOD) and Eligibility Determination Document (W-1E) are available on BOSNet at SSI Subject Index under Food Stamps. The brochure, “A Guide to the Food Stamp Program,” can be found at http://www.ct.gov/dss/lib/dss/pdfs/foodst.pdf.

To obtain additional supplies of food stamp applications and brochures prepare a written request on SSA letterhead and Fax it to 860-424-4954.

Include the document number or publication number on the request. Address the letter to the Duplicating Services Supervisor, Department of Social Services, 25 Sigourney Street, Hartford, CT 06106.

F. References

  • Household Composition for Food Stamp Purposes, SI 01801.060

  • Completing Food Stamp Application Forms, SI 01801.300

  • Expedited Service, SI 01801.150

  • Completing the SSA Transmittal for Food Stamp Applications, SSA-4233, SI 01801.310

  • Exhibit - SSA Transmittal for Food Stamp Applications, SSA-4233, SI 01801.400


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0501801300BOS
SI BOS01801.300 - Application for Food Stamps -- Connecticut (TN 5-253 -- 07/2005) - 10/12/2017
Batch run: 10/12/2017
Rev:10/12/2017