SI BOS01801.303 Application for Food Stamps -- New Hampshire -- (TN 5-255 -- 7/2005)

A. Introduction

The Food Stamp Act of 1977 requires SSA to take food stamp applications from SSI applicants and SSI recipients who live in a pure SSI household. 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 New Hampshire, Department of Health and Human Services (NH DHHS) 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. Completion of Application

Complete the New Hampshire food stamp application, the Application for Assistance (800 7/04), for an individual who:

  • Is a New Hampshire resident,

  • Is an SSI applicant/recipient,

  • Resides in a pure SSI household 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.

The application to be completed is a NH DHHS Application for Assistance (800 7/04) covering various programs. You may check off any and all programs for which the applicant wishes to file. However, the applicant needs to understand that each program of assistance has discrete policy for the application process. For example, a Medicaid applicant must still appear for a personal interview with the appropriate State component.

Consider the following when completing applications:

  • The first sheet of the Application for Assistance gives the applicant general information. This sheet should remain attached to the application when routing it to the food stamp office. On the back at the bottom is a section “Agency Use Only.” DO NOT COMPLETE THIS SECTION. This section is to be completed by the food stamp agency upon receipt of the application.

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

  • The applicant must sign the actual application in Section I on the line titled “Applicant.” If an authorized representative is applying for the individual, the authorized representative must sign on the line titled “Other.” SSA FO personnel should sign on the line titled “Family Services Specialist Signature,” certifying that he/she gave the individual the opportunity to review the application, and provided him/her with a copy of it if requested.

  • The shaded sections in the application annotated Agency Use Only, should not be completed by the SSA FO personnel. The shaded block annotated Referred for XFS located above Section A in the food stamp application should also not be completed by SSA FO personnel.

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

NOTE: SI 01801.300B.2.e. NOTE states that applicants must now state in writing whether or not any household member(s) has been convicted of a drug felony. However, New Hampshire law allows anyone convicted of a drug felony to receive food stamps. Therefore, this statement is not required for New Hampshire food stamp applicants.

2. Provide Applicant Informational Material

Provide the applicant the NH DHHS “Food Stamp Program” (77d 02/04) brochure. This material informs the applicant of the remaining actions to be taken in the application process, the 30-day application processing requirement, and reporting requirements. The local food stamp office address and telephone number is on this material. Also provide the applicant with the sheet entitled “Your Rights and Responsibilities” (811R 05/04).

3. Routing Food Stamp Application

Send the completed food stamp application (using SSA-4233, SSA Transmittal for Food Stamp Applications) to the servicing New Hampshire Division of Family Assistance office within one workday. Be sure to leave the first page giving the general information attached to the application.

NOTE: In expedited service cases, write boldly in red ink, “Expedited Service” across the top of the SSA-4233.

D. List of Food Stamp Offices

New Hampshire Division of Family Assistance provides a current list of district offices on its website.

E. Obtaining Additional Applications and Informational Material

The New Hampshire Application for Assistance (800 07/04), Your Rights and Responsibilities (811R 05/04), and The Food Stamp Program Pamphlet (77d 02/04) are available on the NH DHHS website.

Contact the NH DHHS Logistics Office at (603) 271-4380 or FAX (603) 271-4818 for supplies of the Application for Assistance (800 07/04), “Your Rights and Responsibilities” (811R 05/04), or the “Food Stamp Program” (77d 02/04) brochure.

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

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SI BOS01801.303 - Application for Food Stamps -- New Hampshire -- (TN 5-255 -- 7/2005) - 10/17/2022
Batch run: 04/25/2023