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VIRGINIA DEPARTMENT OF SOCIAL SERVICES NEW MEMBERS TANF APPLICATION

10/24 VOLUME V, PART XXIV, PAGE 122

TEMPORARY ASSISTANCE FOR NEEDY FAMILIES PROGRAM (TANF) APPLICATION TO ADD NEW ASSISTANCE MEMBERS

FORM NUMBER - 032-03-729B

PURPOSE OF FORM - To gather information about new household members for whom TANF assistance is requested.

USE OF FORM – This application is limited to requesting TANF assistance for new household members during the certification period. The application may also be used to apply for SNAP benefits for new members during the certification period although the request to add new household members is not required to be in writing for SNAP. This application may not be used in lieu of an application to apply for initial benefits, to reapply for benefits after a lapse in certification, or to protect the date of application.

NUMBER OF COPIES - One.

DISPOSITION OF FORM – This application must be completed when new household members are added for TANF. The completed application must be filed in the eligibility case record. The application may be used to apply for SNAP benefits for new members

INSTRUCTIONS FOR PREPARATION OF FORM – The application must be completed in its entirety to request TANF assistance for new household members.

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