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SNAP CERTIFICATION MANUAL – APPENDIX A Arkansas Department of Human Services Division of County Operations DCO-256 - DCO-264 List of SNAP Forms Form Number Form Name Revision Date Use How to Access Form Form Fields DCO-256 Action Taken on Administrative Disqualification Hearing or Waiver Oct-12 Used by worker to notify a household that a member has been disqualified due to an IPV determined through a disqualification hearing or because the household waived their rights to a hearing DHS SHARE ONLY Spanish form on DHS SHARE No DCO-259 Action Taken on Your Court Hearing Oct-12 Used by worker to notify a household that a member has been disqualified due to an IPV determined through a court of law. DHS SHARE ONLY Spanish form on DHS SHARE No DCO-260 Notification of Work Registration March-18 • Used in all counties to notify households when a member is work registered. • Used in E&T counties to notify households when a member is referred to the E&T Program. Used in E&T counties to advise work registrants that they may volunteer to participate in the E&T Program. DHS SHARE Order from warehouse No DCO-261 Volunteer Agreement Oct-15 Used by counties to verify volunteer hours for individuals volunteering to meet work requirements. DHS SHARE Yes DCO-261N Notice to SNAP Recipients Subject to Work Requirements March-16 Used to notify households of Work Requirements DHS SHARE Yes DCO-263 Alcoholism and Drug Addiction Treatment Centers Record of On-Site Visit Nov-00 Used by the DHS county office to record on-site visits to treatment centers. DHS SHARE ONLY No DCO-264 Alcoholism and/or Drug Addiction Treatment Center Declaration Form Mar-02 An addendum to the Request for Assistance, this form is used by treatment centers to capture the information needed by the AR to complete an ANSWER interview. DHS SHARE ONLY No