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Date: DATE
Dear NAME:
Thank you for visiting (Enter Organization) today. During the visit, it was determined that you may qualify for Food Assistance. We filled out an online Food Assistance application over the phone and submitted it to the Department of Human Services. Here is a copy for your records.
What Happens Next?
Your application tracking number in PEAK is NUMBER. To complete your application, you will need to speak with NAME County Department of Human Services, and submit documents to verify your income, expenses and residency.
Submitting documents
1. Make copies of the documents listed on the back of this letter.
2. Send the copies in the enclosed envelope to your local county office (remember a stamp).
3. The county must receive your copies by: DATE.
Talk with your local county office
You must speak with a caseworker before your application is final. This can be done over the phone or in person. Respond promptly to any calls or letters from your local county office and contact them immediately if you do not hear from someone within 30 days. Your caseworker may request additional documentation about your income or expenses listed on your application. You can contact the NAME County Department of Human Services office at (AREA CODE) PHONE.
If you are eligible, get your EBT Card
If you are eligible for Food Assistance, your benefits are loaded onto an Electronic Benefits Transfer Card (EBT). This can be mailed to you or you can pick this up at your county office.
What if there is an error on my application?
If you notice any incorrect information in your application, please correct it by:
· Letting the county worker know during your phone call or in person visit
· Completing a Report My Changes request in PEAK
· Calling us and we will complete this via PEAK
Questions?
If you have questions about your application, please call us at (Enter Organization), (Enter Phone Number), during our office hours: (List hours). (Enter Organization) does not administer Food Assistance. We provide assistance through the application process. You can also call your County Department of Human Services office with questions about your application.
Your county office is:
NAME County Department of Human Services
ADDRESS
CITY, Colorado ZIP
(AREA CODE) NUMBER
Additional Resources
We will call you to follow up in a few weeks to answer any questions you may have or to provide other food assistance. We can provide information about additional food resources such as emergency food pantries, summer meal sites for kids, or other food benefits.
Please send COPIES of the following documents. Bank statements might not be acceptable as proof of income or expenses. If you are not sure what to send, please call us at 1-855-855-4626.
Nothing needed! We were able to submit all needed documentation(List out what verifications they need) / Proof of Income
· Pay Stubs
· Statement from Employer of gross wages
· Income tax forms
· Self-employment bookkeeping records
· Bank statements showing direct deposit (if unearned income)
· Agency letter showing monies received (Social Security, Supplemental Social Security (SSI), Veterans Affairs benefits (VA), child support, alimony, unemployment, retirement)
Proof of Medical Expenses, ONLY if over 60 or disabled:
· Billing statements
· Itemized medical receipts like prescription drugs
· Medicare card indicating Part B coverage
· Repayment agreement with physician
Proof of Residency
· Utility bill (electric, water, gas or phone bill that shows your address
· Rental agreement or mortgage statement that shows your address
Proof of Identity
· Birth certificate
· Drivers license or state identification card
· Work or school identification card
· Voter registration card
Other Documents
· Immigration status: immigration or naturalization papers
NOT required if you are only applying for your children who were born in the United States
Please return this checklist with your copies in the envelope provided. The county may require additional documentation.
Enter Organizations Address/Contact Info