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VIRGINIA DEPARTMENT OF SOCIAL SERVICES ESAP APPLICATION

10/24 VOLUME V, PART XXIV, PAGE 129

APPLICATION FOR THE ELDERLY SIMPLIFIED APPLICATION PROJECT (ESAP)

FORM NUMBER -

PURPOSE AND USE OF FORM – This application presents only the information needed to determine SNAP eligibility for households containing elderly members only. Applicants may use this application to apply for ESAP. Applicants are not limited to using the ESAP application. Applicants may use any acceptable Virginia SNAP application. The application must be retained for a minimum of three years.

NUMBER OF COPIES - One.

DISPOSITION OF FORM – The local department must evaluate information presented on the application to determine ESAP or SNAP eligibility.

INSTRUCTIONS FOR PREPARATION OF FORM – Applicants must complete the application fully.

TRANSMITTAL #35