Documents
Instructions
Updated: 5/2003
Purpose
To provide staff a form to verify TANF and/or Food Stamp benefit information to other entities, such as public housing, WIC, etc.
Procedure
When to Prepare
Staff completes the form at the client's request.
Number of Copies
Original only.
Transmittal
Give the completed form to the client in person or via mail or fax.
Retention
There is no retention requirement for this form.
Detailed Instructions
After the client signs and dates the release section and indicates which programs and months they are authorizing release of information for, staff
- enters the name and address of the requestor;
- enters the date and advisor name;
- enters the office address and telephone number;
- enters the case number(s) and the benefit amount information requested; and
- signs and dates the form.