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VIRGINIA DEPARTMENT OF SOCIAL SERVICES ESAP RECERTIFICATION APPLICATION

10/24 VOLUME V, PART XXIV, PAGE 134

ELDERLY SIMPLIFIED APPLICATION PROJECT (ESAP) RECERTIFICATION APPLICATION

FORM NUMBER – 032-03-729D

PURPOSE AND USE OF FORM – Use of this application is limited to recertification or renewal of ESAP cases. This application may not be used in lieu of an application to apply for initial benefits, or to reapply for benefits after a lapse in certification. Applicants are not limited to using the ESAP recertification application as 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 continued eligibility for elderly households.

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

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