Forms

Food Stamp Authorization to Furnish/Release Information

Food stamp recipients must fill out this form at the time of application, recertification or when a new adult household member enters the home. All adult household members must sign and date the form.

The form allows the Department to obtain necessary verifications from other agencies. It authorizes these other agencies to release information to the Department.

• Complete form.
• Once you have completed this form, submit it to your local Department of Social Services office.