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VIRGINIA DEPARTMENT OF SOCIAL SERVICES D-SNAP

10/24 VOLUME V, PART XX, APPENDIX I PAGE 17

Notice Of Action –Disaster Supplemental Nutrition Assistance Program

Form Number – 032-03-0662

Purpose of Form - To notify an applicant of eligibility action taken on an application for disaster benefits.

Use of Form - To be prepared and provided immediately or within the appropriate time standard following action on an Application for Disaster Supplemental Nutrition Assistance Program Benefits.

Number of Copies - Two.

Disposition of Form - The original is to be provided to the household or authorized representative. One (1) copy is to be retained in the case file.

Instructions For Preparation of Form

Complete the identifying information at the top of the form.

Enter the date of the application.

Check the appropriate box to show the disposition of the application.

For approvals, indicate the allotment amount and the period the allotment is to cover (disaster benefit period).

For denials, indicate the reason the application was denied.

For withdrawals, enter the date the household requested the application be withdrawn.

Sign the form. Enter a telephone number for the worker and the telephone number of the local legal aid office.

TRANSMITTAL #35