● If ‘YES
’ provide a case number for SNAP
FIP
or FDPIR. You only need to write one case number. Case
numbers are located on your Notice of Decision. Go to STEP 4.
STEP 3: REPORT INCOME FOR ALL HOUSEHOLD MEMBERS
Report all amounts in GROSS INCOME ONLY. Report all income in whole dollars. Do not include cents.
Gross income is the total income received before taxes.
Many people think of income as the amount they “take home” and not the total
“gross” amount.
Make sure that the income you report on this application has NOT been reduced to pay for taxes
insurance
premiums or any other amounts taken from your pay.
Write a “0” in any fields where there is no income to report. Any income fields left empty or blank will
also be counted as a zero. If you write ‘0’ or leave any fields blank
you are certifying (promising) that there
is no income to report. If local officials have known or available information that your household income was
reported incorrectly
your application will be investigated.
A) Report total household size. Enter the total number of household members in the field “Total Household
Members (Children and Adults).” This number MUST be equal to the number of household members listed in
STEP 1 and STEP 3. If there are any members of your household that you have not listed on the application
go back and add them. It is very important to list all household members
as the size of your household
affects your eligibility for free and reduced price meals.
B) Provide the last four digits of your Social Security Number. An adult household member must enter the
last four digits of their Social Security Number in the space provided.
C) You are eligible to apply for benefits even if you do not have a Social Security Number. If no adult
household members have a Social security Number
leave this space blank and mark the box to the right
