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SNAP CERTIFICATION MANUAL – APPENDIX A Arkansas Department of Human Services Division of County Operations DCO-268 - DCO-286 List of SNAP Forms Form Number Form Name Revision Date Use How to Access Form Form Fields DCO-268 Notice of SNAP/Medicaid Review/Notice of Expiration April-16 Used to notify households that their certification period is expiring and to return the Application for Recertification DHS SHARE Automated No DCO-269 Notice of Missed Appointment Jan-11 Used to notify households that they missed their SNAP appointment DHS SHARE Automated in ANSWER Yes DCO-271 Telephone Report Sept-18 Used by workers to collect information from households that call the DHS county office to report a change in circumstances. DHS SHARE Order from warehouse Yes DCO-272 Access AR Online Application Notice of Interview July-18 Used to schedule either a telephone or face-to-face interview when a household submits an Access AR Online Application DHS SHARE Yes DCO-273 Receipt for SNAP Benefits or Money Jul-00 • Used in DHS county office to: • Act as a receipt for money paid on an overpayment • Acts as a receipt for SNAP benefits withdrawn from an EBT account to repay an overpayment • Gives written permission for the agency to withdraw SNAP benefits from an EBT account to repay an overpayment. DHS SHARE ONLY No DCO-285 Semi-Annual Report and Medicaid Renewal Form April-16 Used by SNAP households subject to semi-annual reporting. Also allows SNAP households with Medicaid to be reevaluated for Medicaid services at the same time. DHS SHARE Spanish form on DHS SHARE Computer generated form Yes DCO-286 Notice of SNAP Recertification Appointment March-09 Used to schedule either a telephone or face-to-face interview when a household submits an Application for Recertification DHS SHARE Spanish form on DHS SHARE Order from Warehouse Yes