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VIRGINIA DEPARTMENT OF SOCIAL SERVICES D-SNAP

10/24 VOLUME V, PART XX, APPENDIX I PAGE 12

Request For Disaster SNAP Assistance

Form Number: 032-03-0663

Purpose of Form: To indicate intent to apply for the Disaster Supplemental Nutrition Assistance Program by an applicant or an authorized representative.

Use of Form: To be completed by an applicant or authorized representative to begin the application process when using the automated Disaster Eligibility System. The form will notify the applicant or the household’s authorized representative of various database screenings.

Number of Copies: One

Disposition of Form: The form must be retained in the case record with the signed Application for Disaster Supplemental Nutrition Assistance Program Benefits.

Instructions for Preparation of the Form: The applicant must complete the identifying information. If this form is completed by the applicant’s authorized representative, the authorized representative must complete the identifying information for the applicant. In addition, the authorized representative must complete his/her own identifying information. The form must be signed by either the applicant or an authorized representative of the household.

TRANSMITTAL #35