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SNAP CERTIFICATION MANUAL – APPENDIX A Arkansas Department of Human Services Division of County Operations DCO-224 - DCO-254 List of SNAP Forms Form Number Form Name Revision Date Use How to Access Form Form Fields DCO-224 Meal Provider Visit Record and Disposal Aug-00 Used by the county to approve or deny homeless meal provider status. DHS SHARE ONLY No DCO-231 Notice to SNAP Recipients May-94 Used in counties where no interview is scheduled at recertification until the household submits an application. Notifies households of the steps they must take to continue receiving SNAP benefits without interruption. DHS SHARE Spanish form on DHS SHARE No DCO-234 Change Report Sept-18 Used by SNAP, TEA and Medicaid households to report changes. DHS SHARE Spanish form on DHS SHARE Order from warehouse Yes DCO-234A Change Report Addendum Sept-18 Explains the limited reporting requirements to SNAP households that are subject to this requirement. DHS SHARE Spanish form on DHS SHARE Order from warehouse No DCO-235 Instructions for Completing Midpoint Review Form Sep-04 Accompanies the Midpoint Review Form sent to households with 24- month certification periods. Explains the process and deadlines for reporting. DHS SHARE Spanish form on DHS SHARE Order from warehouse Yes DCO-238 Declaration of Food Loss July-13 Used by households to request a full or partial replacement of food lost in household misfortune. DHS SHARE ONLY No DCO-243 Travel Reimbursement Documentation Oct-12 Documents transportation costs incurred by E&T recipients. DHS SHARE ONLY No DCO-248 SNAP Adjustment - Automated 248 System Jul-01 Used by workers to authorize a transaction (supplement, restoration, etc.) on daily issuance. DHS SHARE Yes DCO-254 Daily Census Report Jun-97 Used by treatment center to maintain a daily census of drug and alcohol treatment residents who receive SNAP benefits. DHS SHARE ONLY No