Complete the Connecticut food stamp application for an individual who:
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Is a Connecticut resident,
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Is an SSI applicant/recipient,
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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
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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):
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Complete the applicant information on the first page of the application form.
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Complete the remaining questions on the form.
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Have the applicant sign the first page of the form.
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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):
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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.
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Check the Food Stamp Assistance box on page one to indicate that the individual is
applying for food stamps.
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Do not write in shaded areas. All shaded areas are for the CT DSS caseworker's annotations
only.
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Complete all questions not preceded by an asterisk.
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Have the applicant sign the last page of the form.
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Sign your name in the space labeled “Helper's Signature.” Annotate “SSA” next to your signature.
When completing either form:
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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.
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Obtain from the food stamp applicant the documentation needed by the food stamp agency
to process the claim. (See SI 01801.300C.)