Forms

Food Stamp Wage Verification

This form is used to verify a food stamp applicant or recipient's income, pay dates and hours of employment. The form is filled out by the applicant/recipient's employer when they apply for the Food Stamp Program or if a job change occurs.

The benefits specialist either sends the form to the employer or the applicant/recipient may bring the form to the employer for completion. Once completed, the employer must return the form to the local Department of Social Services.

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