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Effective Date: 




Updated: 7/2011


  • To provide potential applicants information about SNAP.
  • To provide income assistance workers with a standardized summary to inform recipients of their rights and responsibilities as participants in SNAP.
  • To notify SNAP recipients that they may request a receipt for any reported change(s).
  • To provide the Social Security Administration with a method of informing pure Supplemental Security Income (SSI) households, whose SSI and SNAP applications are jointly processed, of their rights and responsibilities as participants in SNAP.


When to Prepare

Give Form H1805 to:

  • potential SNAP applicants to inform them about the program, and
  • all SNAP applicants at initial interviews and at subsequent certification interviews to remind them of their rights and responsibilities as SNAP recipients.

Number of Copies

Give or mail one copy of Form H1805 to the potential applicant, the applicant or the recipient.

Form Retention

There is no retention requirement for this form.

Detailed Instructions

All items on the form are self-explanatory.