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SNAP CERTIFICATION MANUAL – APPENDIX A Arkansas Department of Human Services Division of County Operations DCO-74 - DCO-103 List of SNAP Forms Form Number Form Name Revision Date Use How to Access Form Form Fields DCO-74 Request for Services in Alternate County Oct-12 Completed by SNAP households to request service through a DHS county office other than the office in the household’s county of residence. DHS SHARE ONLY No DCO-76 Collateral Statement Sept-18 Used to obtain verification of household composition and/or residence in questionable situations. DHS SHARE Spanish form on DHS SHARE Order from warehouse Yes DHS-80 Claim of Lost, Stolen and/or Forged Assistance Warrant/Check Jul-97 Completed when a client reports a lost or stolen TEA or reimbursement check - e.g., E&T reimbursement check. DHS SHARE ONLY Yes DCO-83 Contributions Statement Sept-18 Used to verify contributions that a household is receiving. DHS SHARE Spanish form on DHS SHARE Order from warehouse Yes DCO-94 Second Party Review Summary Jun-12 Completed by reviewer during second party review. If needed, completed by worker to document corrective action. DHS SHARE ONLY Yes DCO-96 Odd Job Income/ Expense Record Aug-11 Used to record daily income and expenses from odd jobs for the household DHS SHARE No DCO-97 Verification of Earnings Feb-91 Used to obtain verification of earnings from the employer. DHS SHARE Order from warehouse Yes DCO-103 Request for Information at Annual Review March-18 Used to obtain information and/or verification from a household that has submitted an Annual Review. DHS SHARE Spanish form on DHS SHARE Order from warehouse Yes