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1078 Chapter 7:Worker guides • Section 2: SNAP worker guides (07/2026) Form # Title/Use Paper Forms server PDF fill in DHS 491 Statement of Person Living in the Household Form used to verify the financial arrangements and how food is shared when the individual lives with others. X X SDS 540 Notification of Planned Action Hand-initiated notice to the individual when benefits are approved, denied, reduced, or closed, and there is no appropriate computer- generated notice. X X SDS 541 Notice of Eligibility and Responsibility Notice tells the individuals they are eligible, and their first and second month’s benefit amount. None X DHS 824F SNAP Employment and Training Referral Letter Form letter used to advise SNAP E & T volunteers of a scheduled appointment. This notice is not used for mandatory ABAWDs in the time-limit counties. X X MSC 851 Verification of Earnings Form sent to employers to verify earned income for a specified period. This is generally used to determine if there is an overissuance. X X DHS 857 Notice for Free Meals or Free Milk at School or Child Care Center or Head Start Program Give to individuals after they are determined eligible for SNAP so their children can get free school meals or WIC. X X DHS 859C Paycheck Tracking Calendar Tool for ensuring that individuals report all their earned income. None X SDS 905 Notification of Case Transfer Notice of new branch office, sent to the individual when they have moved to an area served by a different branch. X X DHS 1058 Declaration of Indigence Statement of indigence by a sponsored non-citizen, used to exempt the non-citizen from deeming their sponsor’s assets. X X DHS 1219SA Verification of School Attendance X X X MSC 1295 SNAP Claim Data Sheet Used to collect and organize case record information to be used in calculating an overpayment. None X