Downloading a Form to Your Computer

Fillable forms cannot be viewed on mobile or tablet devices. Follow the steps below to download and view the form on a desktop PC or Mac.

  1. Right Click for PC or Ctrl + Click for Mac on the PDF link and click “Save link as” from the menu.
  2. Select the folder you want to save the file in and then click "Save."
  3. Navigate to the folder you saved the file in and Right Click for PC or Ctrl + Click for Mac, then select "Open With" from the menu and select Adobe Acrobat Reader DC.

    Note: Open the PDF file from your desktop or Adobe Acrobat Reader DC. Do not click on the downloaded file at the bottom of the browser since it will not open the PDF in Adobe Acrobat Reader DC. It will try to open the file in the browser that results in the same browser error message.

    If still having trouble viewing or downloading a form, click here.

Effective Date: 



Updated: 5/2003


To provide staff a form to verify TANF and/or Food Stamp benefit information to other entities, such as public housing, WIC, etc.


When to Prepare

Staff completes the form at the client's request.

Number of Copies

Original only.


Give the completed form to the client in person or via mail or fax.


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.