SI BOS01801.305 Application for Food Stamps -- Vermont -- (TN 5-260 - 02/2006)

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 the SSI claimant/recipient purchases and prepares food separately from the rest of the household, the SSI claimant/recipient meets the definition of a pure SSI household. For food assistance purposes the SSI claimant/recipient is considered to be in the SSI claimant/recipient's 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 Vermont Agency of Human Services, Department for Children and Families (DCF), must make the application available to SSA field offices (FOs). The State must also provide SSA with informational material to distribute to food stamp applicants. This material is included with the application.






C. Procedure


1. Completing the Application


Complete the Vermont food stamp application for an individual who:

  • Is a Vermont 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.


The Vermont Application for Food Stamps (ESD 202, R 3/06) is the current application for food stamps. It combines the two application forms (PATH 201 and 202) previously used. The current application is available on the internet and can be printed from there. FOs may also obtain supplies of the application from the DCF offices listed at the end of the application.


To complete the Vermont Application for Food Stamps:

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

  • From page 3 onward complete only the questions annotated with the apple symbol.

  • The questions at the top of page 3 determine whether expedited service is requested. To qualify for expedited service, individuals must not have received food stamps in the month of application AND meet one of the following additional criteria:

    • The household has less than $150 in gross monthly income and no more than $100 in liquid resources.

    • The household’s combined monthly gross income and liquid resources are less than their actual shelter costs (sum of rent/mortgage and utilities).

    • The household includes a migrant or seasonal farm worker and has no more than $100 in liquid resources.

  • Have the applicant sign pages 1 and 13 of the form.

  • Sign your name and date in the spaces labeled “Signature of person helping fill out this form.” Annotate “SSA” under your signatures.

  • 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 with the “Information for Applicants” page at the beginning of the form and the final two pages of the form, containing reporting requirements and the applicant’s rights and responsibilities. This material informs the applicant of 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 DCF office within one Federal workday after receipt of a signed application. (For instructions on completing the SSA-4233, 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 Vermont Application for Food Stamps includes a current list of addresses and phone numbers for Vermont food stamp offices in the “Contact information” section near the end of the form.



E. Obtaining Additional Applications And Information Material


Print the Vermont Application for Food Stamps from the internet, or contact the DCF office serving your area.


F. References


  • Household Composition for Food Stamp Purposes, SI 01801.060

  • Residents of Institutions for Food Stamp Purposes, SI 01801.040

  • 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 BOS01801.305 - Application for Food Stamps -- Vermont -- (TN 5-260 - 02/2006) - 10/17/2022
Batch run: 04/25/2023