APPLICATION for the
FAMILY INDEPENDENCE PROGRAM (FI)
SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP)
REFUGEE ASSISTANCE PROGRAM (RA)
Do you need help filling out this application due to disability or impairment? Do you need an interpreter? If yes, please ask for help at your local DSS Office. To get the address or phone number of your local office, call toll free: 1-800-616-1309 or online at www.dss.sc.gov. Este es un formulario para solicitar beneficios de Independencia Familiar (FI), del
Programa de Asistencia Nutricional Complementaria (SNAP), o del Programa de Ayuda para Refugiados (RA). Si usted necesita un intérprete para poder completar este formulario o para completar su entrevista, pregunte en la oficina local del Departamento de Servicios Sociales y le conseguirán uno.
Social Security Numbers – Citizenship – Immigration Status
Family Independence (FI) and Supplemental Nutrition Assistance Program (SNAP) Applicants:
• You must provide or apply for a Social Security number and citizenship/immigration status on all family members for whom you want cash benefits or SNAP benefits. The Social Security number is not required to file an application for Refugee Cash Assistance (RCA) benefits, the refugee may provide a copy of the SS-5 until the card is received.
• Benefits will not be provided to individuals who do not provide, or show proof of application for, their social security number and citizenship/immigration status.
• Social Security Numbers are not required for non-applicants or persons ineligible for SNAP or cash benefits, however the proof of income must be provided for all members of the SNAP and
FI benefit group.
• If we need information on a person for whom you did not provide information, a DSS worker will contact you to discuss the requirements.
• DSS does not share SSNs or citizenship/immigration status for non-applicants and individuals ineligible for benefits with the US Department of Homeland Security.
• DSS will use Social Security Numbers in the State Income and Eligibility Verification System and other computer matching and program reviews. This information may be verified through other sources when discrepancies are found and may also affect your household’s eligibility and benefit level. “In accordance with Federal law and U.S. Department of Agriculture (USDA) and U.S. Department of Health and Human Services (HHS) policy, this institution is prohibited from discriminating on the basis of race, color, national origin, sex, age, or disability. Under the Food Stamp Act and USDA policy, discrimination is prohibited also on the basis of religion or political beliefs.
“To file a complaint of discrimination, contact USDA or HHS. Write USDA, Director, Office of
Adjudication, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410 or call toll free
(866) 632-9992 (Voice). Individuals who are hearing impaired or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339; or (800) 845-6136 (Spanish).
Write HHS, Director, Office for Civil Rights, Room 506-F, 200 Independence Avenue, S.W.,
Washington, D.C. 20201 or call (202) 619-0403 (voice) or (202) 619-3257 (TTY). USDA and HHS are equal opportunity providers and employers.”
You may also file a complaint of discrimination by contacting DSS. Write DSS Office of Civil Rights,
P.O. Box 1520, Columbia, SC 29202-1520; or call 1-800-311-7220, TTY: 1-800-311-7219.
DSS Form 3800 (JUN 12) Edition of MAR 11 is obsolete.
SOME COMMON TERMS USED IN THE APPLICATION
This application form can be used to apply for the following programs:
Family Independence (FI)
This program may pay you a monthly cash benefit for households with dependent children. It may help you train for work and look for a job and pay child care and transportation costs.
Supplemental Nutrition Assistance Program (SNAP)
This program will help you buy food for your