UNITED STATES VIRGIN ISLANDS DEPARTMENT OF HUMAN SERVICES DIVISION OF FAMILY ASSISTANCE Certification Unit SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP) (aka FOOD STAMP) & CASH APPLICATION COVER PAGE FOR CLIENT PACKET DO NOT RETURN THE FOLLOWING DOCUMENTS ATTACHED TO THIS PACKET. T H E S E A R E F O R Y O U R R E C O R D S!!! 1. Something You Should Know 2. Simplified Reporting Requirements 3. Your Rights/Responsibilities 4. Privacy Act Statement 5. The Smart Family Brochure Page 1 of 7 Rev. 10/2023 SOMETHING YOU SHOULD KNOW s part of the SNAP/CASH process you need to verify information about you and your household. The more verification you submit with your application, the sooner we can determine if you are eligible. Items listed below are the most common examples of verification but there are other acceptable documents to complete the SNAP/CASH application process. Your eligibility worker will advise you of any additional verification or information that is needed. IDENTITY – The identity of the applicant and the authorized representative, if any, must be verified. These are some common examples but not limited to: driver’s license; work or a school identification card; voter’s registration card; birth certificate; permanent resident card; passport; or collateral contact can be used to verify identity. SOCIAL SECURITY NUMBER – You must provide proof of social security number for yourself and everyone in your household. RESIDENCY – Your place of residency will normally be verified. These are common examples but not limited to: identification card with physical address; lease; rent or mortgage statements/receipts; utility bills; or collateral contact may be used to verify residency. INCOME – All income whether earned or unearned. RESOURCES (applicable for CASH and for any member of your SNAP household, who has been disqualified, because of an intentional program violation or noncompliance with the SNAP work requirement) – you must provide verifications of all resources such as: • Checking and savings accounts • Stocks & Bonds • Savings certificates • Certificates of Deposit (CDs) • Vehicles, Boats, Motorcycles, etc. • Land • Additional homes when not income producing Page 2 of 7 Rev. 10/2023 A Earned Income – common examples but not limited to: • All wages or salaries • Contract income • Self-employment income Unearned Income – common examples but not limited to: • Social Security benefits • Alimony • Child support • Unemployment benefits • Veterans’ benefits • Retirement/Pensions • Financial contributions from relatives/friends Acceptable verification documents but not limited to benefit or award letter, check stub, check or record of payment. Acceptable verification documents but not limited to benefit, check stub, contractual agreements, payment record, Income Tax 1040 form. OPTIONAL SNAP VERIFICATION Things you may show us that may make you eligible for more SNAP benefits. SHELTER AND UTILITY EXPENSES – These are common examples of acceptable verification but not limited to. Housing costs: • Rent receipt • Lease or letter from your landlord or roommate • Mortgage statement • Property tax • Condominium fees • Home insurance bill • Other documents showing how much you pay Utility costs: • Bill for water • Electricity • Gas or phone • Lease showing you pay for utilities • letter from your landlord or roommate MEDICAL EXPENSES – This is applicable to members of your household 60 years or older, or members who have a certified disability. Below are some examples of medical expenses but not limited to: • Medical costs not covered by insurance such as co-payments • Medical supplies/equipment • Prescription medication • Dental care • Prescription eyeglasses • Over-the-counter medical items prescribed by licensed practitioner • Cost for attendant, homemakers, home health aides • Transportation costs to and from health appointments DEPENDENT CARE COST – Actual cost of care for children or other dependents when necessary for household members to accept or continue employment. Statement or letter from provider. CHILD SUPPORT PAYMENTS – Documents showing a legal obligation to pay child support like a court order to someone outside of your household and verification of payment. Contact information: ST. CROIX ST. THOMAS ST. JOHN 4102 Mars Hill Frederiksted, VI 00840-3376 Ph: (340) 772-7100, Ext. 7159, 7166 Fax (340) 772-9591 Email: certoffice.stx@dhs.vi.gov 1303 Hospital Ground, Ste. 1 St. Thomas, VI 00802-6722 Ph: (340) 774-0930, Ext. 4378, 4452 or (340) 774-2399 Fax (340) 777-5449 Email: certoffice.stt@dhs.vi.gov Multi-Purpose Building 307 Enighed, Contant Cruz Bay, VI 00830 Ph: (340) 776-6334 Fax (340) 777-5449 Email: certoffice.stt@dhs.vi.gov In accordance with federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, this institution is prohibited from discriminating on the basis of race, color, national origin, sex (including gender identity and sexual orientation), religious creed, disability, age, political beliefs, or reprisal or retaliation for prior civil rights activity. • Program information may be made available in languages other than English. Persons with disabilities who require alternative means of communication to obtain program information (e.g., Braille, large print, audiotape, American Sign Language), should contact the agency (state or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339. • To file a program discrimination complaint, a Complainant should complete a Form AD-3027, USDA Program Discrimination Complaint Form which can be obtained online at: https://www.usda.gov/sites/default/files/documents/ad-3027.pdf, from any USDA office, by calling (833) 620-1071, or by writing a letter addressed to USDA. The letter must contain the complainant’s name, address, telephone number, and a written description of the alleged discriminatory action in sufficient detail to inform the Assistant Secretary for Civil Rights (ASCR) about the nature and date of an alleged civil rights violation. The completed AD-3027 form or letter must be submitted to: 1. Mail: Food and Nutrition Service, USDA 1320 Braddock Place, Room 334 Alexandria, VA 22314; or 2. Fax: (833) 256-1665 or (202) 690-7442; or 3. E-Mail: FNSCIVILRIGHTSCOMPLAINTS@usda.gov Page 3 of 7 Rev. 10/2023 Acceptable verification documents but not limited to bills from providers of health insurance, services, etc., health insurance policies, pharmacy printouts, statement/receipt from provider, transportation bills, medical supply bills DEPARTMENT OF HUMAN SERVICES Division of Family Assistance Program Supplemental Nutrition Assistance Program (SNAP) S I M P L I F I E D R E P O R T I N G R E Q U I R E M E N T S All SNAP HOUSEHOLDS ARE ON SIMPLIFIED REPORTING You must report when your SNAP household’s total monthly gross income is greater than the amount listed on table below, However, if at time of certification your household’s gross income was greater than the amount listed in the table below you are not required to report. (Review the notice of decision your household received to verify the gross monthly income used to certify your household). OCTOBER 1, 2023 to SEPTEMBER 30, 2024 Number of persons you get SNAP for 130% Poverty Gross Income Limit 1 $1,580 2 $2,137 3 $2,694 4 $3,250 5 $3,807 6 $4,364 7 $4,921 8 $5,478 9 $6,035 10 $6,592 Each additional person add: $557 Here is how you calculate your household’s income and what your household needs to do: ▪ At the end of each month, add up all your pay stubs plus any other income you may have received. Do this for each household member over the age of 18. Then total the income for all household members and compare it to the table above for your household size. Use the household size that you had when you applied for benefits. ▪ If your household’s income has increased for your household size from what it was at the time of certification, you must report the increase. You must report it to the SNAP office within ten (10) days after the end of the month. ▪ You will need to provide pay stubs and/or proof of the income change(s). ▪ The ONLY other change your household is required to report is if any member of the SNAP household received a single winning of $4,250.00 or greater from lottery or gambling winnings. Reporting other changes is optional, however households are encouraged to report any changes that the household believe would increase their household’s SNAP benefits. ▪ Your household will be notified via a Notice Of Decision (NOD) if the reported change(s) increased or decreased the household benefits. HOUSEHOLDS RECEIVING CASH ASSISTANCE ARE REQUIRED TO REPORT ALL CHANGES BY THE 10TH DAY OF THE FOLLOWING MONTH THAT THE CHANGE OCCURRED. Page 4 of 7 Rev. 10/2023 UNITED STATES VIRGIN ISLANDS DEPARTMENT OF HUMAN SERVICES Page 5 of 7 | Rev. 10/2023 DIVISION OF FAMILY ASSISTANCE – CERTIFICATION UNIT SNAP /CASH APPLICATION YOUR RIGHTS 1. YOUR RIGHT TO APPLY. You have the right to request an application in person, by telephone, by fax or by mail. You have the right to file an application in person, by telephone, mail or by fax. The amount of benefits for the first month is based on the date the application was received by the DHS, DFA, Certification Unit (SNAP office). You have the right to have your office interview waived and be interviewed by phone. You have the right to apply for food and cash benefits at the same time. The time limits and requirements for cash assistance have no bearing on the Supplemental Nutrition Assistance Program (SNAP). 2. YOUR RIGHT TO PRIVACY. You have the right to be treated in a way which does not invade one’s right to privacy. 3. YOUR RIGHT TO PROGRAM INFORMATION. You have the right to examine the SNAP/CASH rules and regulations. 4. YOUR RIGHT TO EXPEDITED SERVICE. You have the right to receive SNAP within a few days if you have little or no money or income. 5. YOUR RIGHT TO PROPER NOTICE. You have the right to be told in writing the specific reason for denial of SNAP/CASH and the policy on which the decision is based. You have the right in most instances, to 10 days advance notice of the program’s intention. You have the right to have the SNAP/CASH Office make a decision and provide an opportunity to participate if found eligible within 30 days after the filing of an application, provided you have supplied the necessary and adequate information (orally or in writing). 6. YOUR RIGHT NOT TO BE DISCRIMINATED AGAINST. You have the right to fair and equal treatment and freedom from discrimination. You have the right to considerate and respectful treatment from SNAP Staff. 7. IF YOU FEEL WE TREATED YOU DIFFERENTLY: This institution is prohibited from discrimination based on race, color, national origin, disability, age, sex and in some cases religion and political beliefs. USDA Non-discrimination Statement In accordance with federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, this institution is prohibited from discriminating on the basis of race, color, national origin, sex (including gender identity and sexual orientation), religious creed, disability, age, political beliefs, or reprisal or retaliation for prior civil rights activity. Program information may be made available in languages other than English. Persons with disabilities who require alternative means of communication to obtain program information (e.g., Braille, large print, audiotape, American Sign Language), should contact the agency (state or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339. To file a program discrimination complaint, a Complainant should complete a Form AD-3027, USDA Program Discrimination Complaint Form which can be obtained online at: https://www.usda.gov/sites/default/files/documents/ad-3027.pdf, from any USDA office, by calling (833) 620-1071, or by writing a letter addressed to USDA. The letter must contain the complainant’s name, address, telephone number, and a written description of the alleged discriminatory action in sufficient detail to inform the Assistant Secretary for Civil Rights (ASCR) about the nature and date of an alleged civil rights violation. The completed AD-3027 form or letter must be submitted to: 1. Mail: Food and Nutrition Service, USDA 1320 Braddock Place, Room 334 Alexandria, VA 22314; or 2. Fax: (833) 256-1665 or (202) 690-7442; or 3. E-Mail: FNSCIVILRIGHTSCOMPLAINTS@usda.gov For any other information dealing with Supplemental Nutrition Assistance Program (SNAP) issues, persons should either contact the USDA SNAP Hotline Number at (800) 221-5689, which is also in Spanish or call the State Information/Hotline Numbers (click the link for a listing of hotline numbers by State); found online at: http://www.fns.usda.gov/snap/contact_info/hotlines.htm To file a complaint of discrimination regarding a program receiving Federal financial assistance through the U.S. Department of Health and Human Services (HHS), write: HHS Director, Office for Civil Rights, Room 515-F, 200 Independence Avenue, S.W., Washington, D.C. 20201, or call (202) 619-0403 (voice) or (800) 537-7697 (TTY). This institution is an equal opportunity provider. Créole Français Si ou gen difikilte pou konprann anglè oswa ou gen yon andikap, asistans lengwistik gratis oswa lòt èd ak sèvis disponib sou demann. Tanpri rele: STT – (340) 774-0930, Ext. 4378 or STX – (340) 772- 7100, Ext. 7199. Español Si tiene dificultades para entender la lengua inglesa o presenta una discapacidad, puede solicitar asistencia lingüística y otros tipos de ayuda y servicios sin coste alguno. Llame al siguiente número de teléfono: STT – (340) 774-0930, Ext. 4317 or STX – (340) 772-7100, Ext. 7166 or 7159. ACCESS TO FREE LEGAL SERVICES. You may contact the Office of Legal Services for free legal service at: St. Thomas/ St. John/ Water Island District >>> No. 1832 Kongens Grade Charlotte Amalie, VI 00802 Ph: (340) 774-6720 *** Fax: (340) 777-8686 No. 3017 Estate Orange Grove Christiansted, VI 00820-4375 Ph: (340) 773-2626 *** Fax: (340) 778-8593 <<