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COMPLETE FOR SNAP ONLY DEDUCTIBLE EXPENSES Shelter Expenses are used as a deduction from your household’s countable income to determine the amount of SNAP benefits your household may be entitled to receive. Expenses that are not reported and verified will not be allowed as a deduction from your countable income in determining your SNAP benefit amount. To claim expenses in the future, your household will need to report and verify expenses in which adjustments to your benefits, if any, will take effect the month after the verification is received by the department. SHELTER EXPENSES 26. Does any person or agency outside your household help pay for or provide, at no cost to you, any of the expenses listed below? Yes  No If Yes, (  ) the expense(s): Rent  Utilities  Taxes  Mortgages  Personal Supplies  Food  Household Supplies Medical Care  Clothing  Other If Yes, what person or agency helps pay or provide the expense(s)? Do you need to pay them back?  Yes  No 27. 28. 29. Is anyone in your household working off any part of the rent?  Yes  No If Yes, indicate amount $ Do you live in Public Housing?  Yes  No Does your household pay any shelter and/or utility expenses (such as rent, electricity, property tax)?  Yes No Check Yes or No and complete information for each item below: YES NO ITEM HOW OFTEN BILLED (Monthly, Weekly) CURRENT BILLED AMOUNT YES NO ITEM HOW OFTEN BILLED (Monthly, Weekly) CURRENT BILLED AMOUNT Rent Gas Boat Slip Propane, Kerosene, Coal, Wood Mortgage/2nd Mortgage Telephone Sales/Local Property Tax/ Assessments Utility Installation Fees Homeowner’s Insurance Unoccupied Home Expenses Water Car Payment (If car is used as a home) Garbage, Sewer, Trash Collection Car Insurance (If car is used as a home) Electricity Other (Specify) LIST YOUR LANDLORD’S NAME, ADDRESS AND PHONE NUMBER 30. Are you billed separately for utility cost?  Yes  No If Yes, (  ) check the utilities: Electric/Gas  Water  Sewer/Trash If yes, choose one of the following options “A” or “B” for each utility billed separately: Electricity/Gas Water Sewer/Trash A. Standard Utility Allowance (SUA) The SUA is an amount which reflects the average statewide amount spent for specific utilities and other mandatory fees. You may choose to have either the actual cost or the SUA for each utility cost used in determining the SNAP shelter cost deduction amount. B. Actual Utility Costs If you Choose to use ACTUAL COSTS, you will need to verify these costs. 31. ANY QUESTIONS REGARDING THESE OPTIONS CAN BE DISCUSSED WITH YOUR WORKER. ONCE YOU SELECT AN OPTION, YOU CAN CHANGE IT ONLY ONE TIME IN 12 MONTHS. Does your room or rent payment include meals?  Yes  No If Yes, complete the following: PAYMENT ROOM/MEALS NO. OF MEALS PROVIDED PER DAY MONTHLY AMOUNT $ $ DHS 1240 (REV 04/2024) Page 8 of 11 Attachment A-2, Page 10 of 18