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NYS Office of Temporary and Disability Assistance- TA and SNAP Employment Policy Manual

Appendix A- Page 10 Rev. 3/2022 interviewing as part of their training. Districts may also incorporate elements of the form into local equivalents.

The first section allows the worker to maintain a record of procedural and non-financial elements of the SNAP eligibility determination including, for example, that the worker verified the application/recertification form was signed, and the date the interview was completed. Additionally, the section prompts workers to verify that the household has verified in writing or electronically that an authorized representative is able to act on its behalf for households with authorized representatives.

Part A also includes sections that collect information necessary to accurately determine a household’s SNAP eligibility including:

• Household Size: information about who resides in the household and their relationships is necessary to determine the required SNAP household members. The section also includes an area to note any ineligible household members (e.g., students, non-citizens, and non-compliant Able Bodied Adults Without Dependents);

• SNAP Household Income: all household income must be disclosed and verified, including type of income, amount and frequency received, whether the income is ongoing and when the income began if it is not already part of the case record;

• Categorical Eligibility: categorical eligibility must be determined for each household and workers may reference the LDSS-4943 Categorical Eligibility Desk Aid as a resource. Households not categorically eligible are subject to the resource test and must provide verification of all countable resources;

• Participant Characteristics: workers should ask the education level and primary language questions if they have not been completed on the application/recertification form. Workers must also explain that the questions are voluntary and are only used for federal reporting purposes and that the information is reported anonymously;

• Residence-Shelter Type/Expenses: information about the household’s current address, shelter type and expenses must be collected and verified if applicable. Workers must also collect information about shared living situations if applicable;

• Heat-Utility/Expense: information about the household’s responsibility for heating and/or utility expenses must be collected to determine the household’s fuel/utility code and Standard Utility Allowance eligibility;

• Standard Utility Allowance: subsections A and B assist the worker to make the correct Standard Utility Allowance determination for the household and the LDSS-4902 SNAP Utility Allowance Table is available as a reference. Additionally, workers should reference 18 TA-DC012 $21 Nominal HEAP Benefits Advance Payment to determine