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COMMONWEALTH OF VIRGINIA DEPARTMENT OF SOCIAL SERVICES SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP)
INTERIM REPORT FORM - REQUEST FOR ACTION
Case Name:______________________
Case Number:____________________
Agency:_________________________
Date:___________________________
You were required to send in a completed Interim Report to this agency by the fifth (5th) of the month for your SNAP case. Please note the information checked below.
( ) We have not received an Interim Report form from you. Complete the Interim Report form that was sent to you. When you send the Interim Report form in, please make sure you answer every question, give us all the information the report asks for, and sign and date the report.
( ) The Interim Report form you submitted was incomplete. The form you submitted is attached. This form is incomplete because:
1. ( ) You did not answer every question. Please answer the following questions: ________________________________________________________
________________________________________________________
2. ( ) You did not sign and/or date the report. Please sign and date the report.
( ) Proof of some of the statements made on your report was missing. Please send in the following: ___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
You must return a completed Interim Report and proof of any changes within ten (10) days. If you do not submit a completed report, your SNAP case will close. You will not receive an additional notice unless the information you submit changes your benefits.
If you are unable to complete the Interim Report or if you have any questions about how to complete it or what information you need to send in, please ask for help. For more information about the Interim Report process, see Part 14.C of the SNAP Manual.
If you have taken the actions listed above, please disregard this reminder.
032-03-0649-12-eng (09/2024) Benefit Program Specialist Telephone Number For Free Legal Advice Call
1-866-534-5243