Get What You're Entitled To: The New Food Stamp Forms

Why. Oh. Oh. Major funding for this program was provided by friends of Iowa Public Television. The. Changes are taking place within I was Department of Human Services changes that will affect many of you who are currently receiving public assistance and food stamps. As you know how much aid you get each month depends on your income expenses and other related circumstances. But soon you'll need to fill out a monthly report if you want to continue to receive public assistance. Recently many of you received an information booklet monthly reporting in you in the mail. You might want to take it out now and shortly on Explain how you can get the benefits to which you're entitled.

The new public assistance eligibility report is a whole new way of doing things. Many of you. Your information booklet will help you in filling out the report. So follow along as we explain how the monthly report affects your household. Your first reaction to the report may have been one of apprehension or confusion. But as we break it down into sections you'll see that the report is actually quite easy to fill out. Once a month every month. You'll receive a report the form is all part of new federal legislation now being implemented in Iowa by reporting your income and expenses each month. You can be assured of the public assistance and benefits to which you're

entitled. As an example if your income changes during one month so may the amount of assistance you'll receive. It's extremely important that you fill out and return the report each month. If you don't your benefits could be delayed or even stopped entirely. So don't forget so decided time during the first part of each month to fill out and return the form. If you have problems filling it out your worker will be glad to help you. Some of you will also receive this questionnaire dealing with this report and the program you're now watching. After you fill out the report please answer the questions in the questionnaire and return it with the rest of the material. Before we go on it might be wise to explain some words will be referring to throughout the rest of this program. First there is the budget month. As an example let's say you received a blank monthly reporting form during the last part of March in the upper right hand corner of the form it will say this report is about the month of March 1st

to the thirty first. In this particular case March will be your budget month. What that means is that all the questions that you answer in the rest of this form will be about the past month of March. The following month April will be your report month directly below the budget month statement will be another statement telling you to return the report no later than in this case. April 5th April 5th is the due date that means the report must be filled out signed dated and in your worker's hands by that date. That does not mean putting it in the mail by April 5th. Instead the report must be received by your worker by that day so be sure to drop the report in the mail at least several days before the due date the due date will always be the fifth day of the report month except when it falls on a weekend or holiday. Then your report must be back to your worker by the following workday. Finally there is the

benefit month. This is the month that you receive your benefits. In our example the benefit month will be May 2 months after the Budget month below the due date as a box asking for your name address and telephone number only fill out this section if there has been a change since your last report. The section to the left in titled Iowa Department of Human Services should not be filled out but left to the Human Services Department. Next is a box and titled read carefully review that section each time you receive the report. Since new information may be supplied there you'll notice that it mentions what you should do if a star's position next to the heading of a section whenever you see a star next to a box. You must send some sort of proof such as pay stubs or receipts whenever you send in items of proof. Be sure to sign your name on the back of each item so your worker can return them to you. We'll talk more about types of proof later.

Now it's time to begin filling out the actual report in item number one persons in your household. You'll be given a list of people who've been living with you in your home. It's your job to go through the list and check off in the column on the right whether that person is still living with you. For every time you check no you must explain why that person is no longer living with you. Write down your explanations in the space provided in Item Number 13 near the end of the report form. If someone is living with you now and his or her name is not on the list add that name to the bottom of the list and that person's relationship to you. You'll also want to list that person's social security number and date of birth. If you want aid for that person circle the type of aid you want for them at the bottom of item 1. Aid can either be ADC refugee assistance food stamps or medical assistance. Your worker will send you a public assistance application form so that you can apply for that

person. Remember you want to list anyone whose name is not on the list but is currently living with you. As noted on page 9 of your information booklet you must report if anyone in your home was born has died has moved in or out as gotten married or divorced. Is temporarily absent. Change his or her name has become disabled or is no longer disabled receive the Social Security number or had a change in citizen or alien status during the budget month. Item 2 refers the people who are living with you and who are going to school. The first question asks whether there are any persons included in your household who are 16 years old or older. Actually the question is only referring to persons of that age who are going to school. If you check no. Go on to the next section. But if you check yes list those persons names. If that person is still in school the name of

the school or training program and whether he or she is going to school full time half time or part time. Next check yes or no whether anyone living with you under the age of 16 has dropped out of school. If the answer is yes explain why in item 13. Item 3 asks if anyone in your household was on strike during the budget month. If someone was on strike for any part of that month list that person's name and when they first went on strike. Even if the strike started before the beginning of the budget month if that person is no longer on strike list when he or she went back to work. Before filling out items number four and five you'll need to gather any payroll stubs layoff slips or income receipts. If no one received income from work during the budget month check the no box and move on to item number five. If someone did receive income check the yes box and list that person's name.

Notice that there is a star beside item number four as we mentioned earlier the star indicates that you must supply proof when you return your monthly report. In this situation that could include pay stubs or if you stopped receiving an income a layoff slip obviously of no one started stopped or continued to receive income during the budget month. You'll not need to send any proof. Next List your employer's name and address. If someone in your household was self-employed during the budget month put the word self-employed in the employer's name an address box. If you are self-employed. They will not need to provide proof of your income unless you are a worker and structured to do so. Examples of self-employment could include selling items door to door babysitting doing odd jobs providing room or board to a renter or managing rental property. Next List the dates that

individuals in your household receive each paycheck during the budget month. Write down the full amount of each paycheck before any taxes were taken out. You'll also want to list any tips or bonuses or commission you may have received during the budget month. Finally write down how many hours that person worked during the month. Item 4 has space for only two sources of income. If your household has more than two check the yes box and put any additional information in item number 13. In this section you must also list as income any advanced earned income tax credit payments to which are in title. Before we go on make sure you've included any necessary proof. In item 5 you're being asked of anyone in your household received any income other than that from work ATC or refugee assistance. As we stated on page 17 of the information booklet that could include Social Security

veterans benefits unemployment benefits strike pay workman's compensation disability insurance pensions military pay child support alimony inheritances court settlements interest income loans student loans grants or scholarships or income from an alien sponsor. List the person's name who received any of the income and check whether that income started continued or stopped during the budget month. Also list the type of income it is. If anyone in your household is receiving a loan grant or scholarship to attend college or a university list that person's name in item number 5 and put the word see attached sheet under the heading of what kind of income is it that attempts to list all the loans grants and scholarships which the student is receiving for the school period in which the budget month falls. If you have not previously send proof of

such a source of income scented with this report form. Also list all the tuition and mandatory fees assessed by the school during the budget month. If you have not sent proof before. Send it with this report form proof might include a statement from the school listing the tuition and assessed fees as the star the head of item 5 signifies. You must provide proof of all sources of income in this section. List the amount of each payment that person received the type of income whether it will continue or not and the date that person received the income. Item 5 only has space for two sources of other income. If you have more check the yes box at the bottom of that section with the additional information in the supplied space of item 13 in Item 6 you'll not need to supply proof unless your worker asks for it.

But you do need to take into account any resources or property that anyone in your household may own. The first question asks whether anyone in your household owns a car truck motorcycle or boat. Any means of transportation of value should be listed here. The next question asks whether anyone owns a home or any other property where they do not live. List each piece of property. Next check whether anyone owns any other resources of value and list them here. They might include items like a stamp collection a burial lot stocks bonds or even livestock for these three questions. List how much money if any is still owed on the property. What you consider the item to be worth. And whose name it's listed or registered in. You must also check whether or not you have a savings or checking account. List the current balance in each account. Where it's located and whose name or names are on the account.

We are close to half way through the form now so let's review the first six items in item 1. List any additions to your household and the type of aid you want for any new person and item to list any person 16 years old or older who is going to school. Also explain if anyone under 16 has dropped out of school. In item 3 your list anyone in your home who's been on strike during the budget month. Including the dates that person left work and returned to work in addition to listing individuals who had received income from work during the budget month. Item 4 is also the first section that requires proof to be sent with your finished report form. Item 5 is much the same as Item 4 except that it includes any income other than that from work ATC or refugee assistance. Finally in Item 6 you're asked to list any property or resources of value and how much you

think they're worth. As I mentioned earlier the report form is not as difficult as it may have originally seemed. If you get stuck on some question either check your information booklet or contact your worker who will be glad to help you with any problems. Let's go on to item number 7. Here you're asked whether any person or agency outside your household help to pay for child daycare or the expenses of a disabled adult living in your home. Item 7 also asks whether anyone helped you in paying for any of your shelter costs. They could include rent mortgage payments and utilities. If you answer no. Go onto item 8. If you answer yes list who is helping you pay for those expenses remember to include low rent leased housing or HUD in the section. Also list what Bill is being paid to whom the money is being paid

and how much is being paid. As you can see by the star the head of the section. Item 7 also requires that you send proof of any assistance in this case. Prove might be a signed or dated note from the person who is helping you. On that note include the total amount they paid during the budget month and whether or not that person will be helping you again in future months. Item 8 should have a star next to the heading of that section because of a misprint. Some of your report forms may not have that star. It might be a good idea to pencil it in now to remind you that you must send proof with this section. You are only required to fill out item 8. If you had to pay someone to take care of your children or a disabled adult while you were at school or work. If you did not go onto item 9 if you did have such expenses list the person who is receiving the care the name and address of the person who is supplying the care and how much they're billing you. And

the reason for the care. Make sure you send in proof of your expenses. It might include a bill or a receipt from a babysitter or a home health aid. Item 9 deals with whether or not you want food stamps next month. If you do not check the box at the right. If you do want food stamps fill out the rest of the section. List anyone in your household who is disabled or is 60 years of age or older who must pay some of their own medical bills. Next List the dollar amount of the medical expenses and how often they must be paid. As noted on page 25 of your information booklet medical expenses can include doctor hospital and dentist fees prescriptions health insurance premiums medical transportation costs and medical supplies over-the-counter drugs like cold medicine or aspirin are not allowed expenses.

In the second part of item 9 your list any shelter costs whether they be rent or house payments. List how often you make each payment. Also list any property taxes you've been assessed. The cost of your homeowner's insurance and the cost of any special assessments like the cost of a new sewer line in your neighborhood. You only need to send proof of shelter costs if they've changed or you've moved since last month. Next check the box next to the utilities you pay. List the amount of each bill and how often you receive it. If you are using a standard utility allowance you do not need to send proof with the report but if you are using your actual utility bills you must send proof of your utility costs with each monthly report. Finally check whether or not everyone who must do so agrees to register for work or job search.

If someone in your household does not agree to register they will not be eligible for food stamps. Also in this section you should if you can list the name of someone outside your household who could act as your representative to pick up your food stamps or to buy food for your household if you were not able to do so. You only need to fill out item 10 of you or an absent parent of the children in your home added dropped or change health insurance coverage for any eligible person during the budget month. If no one change go onto Item 11. If someone did have a change in their health insurance coverage list that person's name. The policy holder and the policy number the service covered the name and address of the insurance company or the employer's name if he paid the insurance. And what happened under the service covered category. Explain if the insurance pays for things like doctors

drugs dentists hospitals or major medical. Again only fill out item 11 if it pertains to you. If you or your spouse paid support or alimony to persons outside of your home. Fill out this section if you're including your spouse in this section. That person must be living with you first. List the person making the payment that person's relationship to you. The dates of each payment and finally the amount of each payment. If you are receiving child support don't report it in the section reported under item five other income. If you did pay support or alimony to a person outside your home during the budget month you must send proof. Such as a receipt from the person you paid or a receipt from the clerk of court or a friend of the court if the support is court ordered. Item 12 covers any changes that might take place in the next two months. That includes changes in income or expenses.

Go back over the last 11 items and if you come across anything you think might change in the next two months check the yes box that explain what those changes will be. If you need more space. Attach additional pages to the report or go onto item 13 and explain there. If you don't expect any changes over the next two months check the no box and go onto item 13. Actually we've mentioned item 13 several times already. All that this space is for is to give you a place where you can explain any of your answers from previous sections. Now that we're close to the end let's review some of the final items. In Item Number Seven you're asked to list any person or agency that helps pay for child daycare or for disabled adult care expenses. Also list anyone who helps pay for rent mortgage payments or utilities. Item Number 8 asked whether or not you had any expenses for childcare or for a

disabled adult during the budget month. Remember to send proof with this section. Item 9 wants you to list anyone age 60 or older or any disabled person who had medical expenses and how much they were. It also asks for shelter costs and utility costs. Don't forget to answer the question about registering for work or job search. You should also list someone who could act as your representative to pick up your food stamps or buy food for you. If you are not able to do so. Item 10 wants to know whether or not anyone in your household had a change in their health insurance coverage during the budget month. List any support or alimony you or your spouse paid to a person outside your home in Item 11. Item 12 is basically a catch all for the next two months. It simply wants you to list any expected changes in your income or circumstances over the next two months. And finally item 13. This section is nothing more than an additional

space where you can explain your answers more thoroughly. If you need any help filling out your report feel free to contact your workers for assistance. The only thing left to do is to sign and date your report. But before you do that read through the four statements at the top of item 14 by signing the report. You've automatically agreed to these four conditions. Also the date that you sign your name is very important even though you may have received your blank monthly report sometime before the end of the budget month. Don't sign it and date it any earlier than the last day of the budget month. If you do your work you will not know if you reported everything for that month and will have to send the report back to you to review. Sign and date again. Remember to return the report no later than the fifth day of the report month. If it's not returned by the due date you'll receive a notice telling you that your case is being

cancelled. The notice will also tell you what you need to do to keep your case from being canceled and how long you have to do it. If you don't do what the notice tells you to do your case will be cancelled. There may also be times when you're not eligible for benefits for just one month. One reason this might happen is if you are paid weekly during some months you'll receive 5 paychecks instead of 4. If you receive more money than your benefits allow your worker may suspend your case but not cancel it. That means you wouldn't get any benefits for that benefit month. But if you return your next monthly report and you are eligible for benefits your case will automatically be re-opened and you'll receive your benefits the following benefit month. However if you become ineligible for more than one month your case will be cancelled and that means you must fill out a new application form. If you want to reapply for benefits you'll get a notice if your case is going to be

cancelled or if your benefits will be going up or down if taken against you that you feel is wrong. You do have the right to appeal. Usually if you appeal within ten days of the time the notice is issued the item you're appealing will not change and your benefits will be continued until a decision is made on your appeal. If you lose your appeal and your benefits had been continued while the appeal was being considered you may have to repay the extra benefits you received your benefits would not be continued while under appeal if you did not return a complete monthly report form. Now it's time to sign the forms fill out your full name the month day and year. If you can only leave a mark. Be sure to have a witness sign the form. If someone helped you to complete this form have that person sign their name also. If there is another parent or

spouse in the home have that person sign and date the form to before you mail off the report. Read through item 15. It tells you your rights and responsibilities for the programs covered by the report form. The only thing left to do is to fold up the form put it in the globe and drop it in the mail. Make sure that when you place the materials in the odd bloke your local office address appears through the window. But before you mail the report check to see that you've done everything you were supposed to do go through the entire form and see that all major questions have been answered. Next check to see that the report is signed and dated no earlier than the last day of the month. And finally make sure that you've included all your items of proof that the report form asks for and that they're signed. So your worker can return them to you.

As we mentioned at the beginning of this program some of you received a questionnaire asking you questions about this report form and the show you've been watching. Please take a few minutes to answer the questions and return them with your report form in the self-addressed envelope. We've sent along with a questionnaire. And that's all there is to it. As I said earlier the report is actually quite simple once you break it down. And if you make sure to fill it out properly and return it to your worker by the due date you'll be getting the benefits to which you're entitled. Major funding for this program was provided by friends of Iowa Public

Television.