About this Application

How do I apply for benefits?
To complete your application, fill out the questions in this application. You can start your application today by giving us your name, address, and signature or the signature of your authorized representative on the “electronic signature” screen. You can file your application immediately even if it only contains these three items.

How soon can I receive help with food?
Expedited Service:
We decide if you are eligible for food assistance within 7 days if you show proof of your identity and meet one of the following:

• Your household will have less than $150 gross income and less than $100 liquid resources this month.
• Your household's income and resources are less than your monthly rent and utilities.
• Your household includes a destitute migrant or seasonal farm worker.

Standard Service:
If you don’t qualify for expedited service, you may still be eligible for food assistance with higher income. If you are not eligible for expedited service, we may take as many as 30 days to determine your eligibility, but most are processed much earlier. We process more than half of all applications within 5 days. 

How soon can I receive help with cash?
We process your application as quickly as possible but it may take from 30 to 45 days to determine your eligibility, depending on what program you are applying for.

Benefits are issued by the day after we decide you are eligible.
We must decide if you are eligible for Food Assistance within 30 days of the date you submit your application. Food assistance usually starts the day we receive your application. If you are submitting your application from an institution, the start date is the date of your release or discharge. Cash benefits usually start the day we have all the information to decide you are eligible.

Civil Rights
In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, this institution is prohibited from discriminating based on race, color, national origin, religion, sex, (including gender identity and sexual orientation), religious creed, disability, age, political beliefs, or reprisal or retaliation for prior civil rights activity.

Program information may be made available in languages other than English. Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the responsible agency (state or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339.

To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at: https://www.usda.gov/sites/default/files/documents/USDA-OASCR%20P-Complaint-Form-0508-0002-508-11-28-17Fax2Mail.pdf, from any USDA office, by calling (833) 620-1071, or by writing a letter addressed to USDA. The letter must contain the complainant’s name, address, telephone number, and a written description of the alleged discriminatory action in sufficient detail to inform the Assistant Secretary for Civil Rights (ASCR) about the nature and date of an alleged civil rights violation. The completed AD-3027 form or letter must be submitted to:

1. Mail: Food and Nutrition Services, USDA
            1320 Braddock Place, Room 334
            Alexandria VA 22314; or
2. Fax: (833) 256-1665 or (202) 690-7442; or
3. Email: FNSCIVILRIGHTSCOMPLAINT@usda.gov

This institution is an equal opportunity provider.

Immigration Status and Social Security Numbers
You may be able to get assistance for some people you live with even if others you live with can't get help because of immigration status. You must tell us the status of anyone who applies. Alien status of applicant household members may be subject to verification by USCIS (formerly known as INS) through the submission of information from the application to USCIS. Information received from USCIS, based on this submission, may affect eligibility and benefit amounts.

We have medical programs that cover some people who can't prove they are in the country legally.

Under Federal Law (45 CFR §205.52, 7 CFR §273.6), you must give us the Social Security Number (SSN) for anyone you live with who applies for Medicaid, TANF, TSOA or food assistance. We may also need SSNs of parents and spouses who live with you but don't apply. We have medical programs for some people who don't have SSNs.

If you're applying for Food Assistance and other programs:
We must follow the SNAP rules for processing your application. This includes processing the application within time limits, issuing proper notices, and advising you of your administrative rights. We cannot deny your Food Assistance just because your application for other assistance programs was denied.

If you're applying for the Child Care Subsidy Program:
Your information will be sent to and processed by the Department of Children, Youth, and Families.

Citizenship and Identity for Washington Apple Health
U.S. citizens must prove citizenship and identity to receive Washington Apple Health. We will work with you to obtain the proof. If we require a document that will cost you money, we will send for it and pay the cost. We don’t need proof for anyone in your household who receives Medicare, Social Security Disability Insurance (SSDI) based on their own disability or Supplemental Security Income (SSI). Proof includes but isn't limited to:

Proof of Citizenship

• U.S. passport.
• Certificate of Naturalization or Citizenship.
• Tribal membership card with picture.
• Official state/county U.S. birth certificate.

Proof of Identity

• State driver's license.
• State identity or military ID card with picture.
• U.S. American Indian/Alaska Native tribal document.
• Completed Citizenship Documentation and Identity Declaration form for children under 16.

Privacy and Cash and Food Assistance
The Food and Nutrition Act of 2008, as amended permits the department to collect the information we ask for on the application, including the SSN of each household member. We use SSNs to check identity, verify eligibility, prevent fraud, and collect claims. We exchange information with other agencies to manage our programs and follow the law. Providing the requested information is voluntary. However, failure to provide a SSN or proof of application for a SSN without a good reason will result in the denial of Basic Food assistance to each individual failing to provide a SSN. We verify some information with computer matching programs, including the federal Income and Eligibility Verification System(IEVS).

Information reported to the Department of Social and Health Services may affect eligibility for health care coverage administered by the Health care Authority and the Health Benefit Exchange.

We use this information to:

• Decide who is eligible for our programs.
• Collect overpayments.
• Manage our programs.
• Make sure we follow the law. 

We may give this information to:

• Federal and state agencies for official use.
• Law Enforcement agencies pursuing people who are fleeing to avoid the law.
• Private collection agencies to collect food assistance overpayments.

Food Assistance Penalty Warning
We check with other agencies that your information is correct. If any information is incorrect, the persons who apply may not get Food Assistance.

Any member who breaks any of the rules on purpose can be:

• Subject to prosecution under other applicable Federal and State laws.
• Barred from SNAP for one year to permanently.
• Fined up to $250,000.
• Imprisoned up to 20 years.
• Barred from SNAP for an additional 18 months if court ordered.

If a court finds you guilty of:
Receiving benefits in a transaction involving:                         You may be:

• The sale of a controlled substance................................. Disqualified from two years to permanently.
• The sale of firearms, ammunition, or explosives...............Permanently disqualified.
• Trafficking benefits of more than $500 combined..............Permanently disqualified.
• Residency or identity fraud.............................................Disqualified for 10 years.

How soon can I receive help with Long-Term Services and Supports (LTSS)?

It will depend upon the program you apply for. If you need help paying for nursing home care, we can cover up to three months prior to the month you apply as long as you are eligible in each month. Most services that are provided in your own home or in a residential setting such as an assisted living or adult family home begin once you are found eligible based upon your income and resources and after you have had an assessment to determine if you meet the level of care requirements for the program. We do not pay for LTSS until you have an eligible provider in place to provide care for you.

To schedule an LTSS assessment, please contact Home and Community Services (HCS) central intake at:

• Region 1 North HCS-Pend Oreille, Stevens, Ferry Okanagan, Chelan, Douglas, Grant, Lincoln, Spokane, Adams and Whitman: 1-509-568-3767 or FAX 509-568-3772
• Region 1 South HCS-Klickitat, Kittitas, Yakima, Benton, Franklin, Walla Walla, Columbia, Garfield and Asotin. Contact the local Home and Community Service (HCS) office based on county: 1-509-568-3767 or FAX 509-575-2286
• Region 2 North HCS - Snohomish, Whatcom, Skagit, Island Counties 1-800-780-7094 or FAX 425-977-6579
• Region 2 South HCS - King County 206-341-7750 or FAX 206-373-6855
• Region 3 HCS- Pierce, Kitsap, Thurston, Mason, Lewis, Grays Harbor, Pacific, Cowlitz, Clark, Clallam, Jefferson Counties 1-800-786-3799 or 360-664-9138. FAX 1-855-635-8305

For information about applying for services through the Developmental Disabilities Administration:
https://www.dshs.wa.gov/dda/developmental-disabilities-administration-services-programs

If you have an unpaid caregiver who provides care for you in your home and you are over the age of 55, you may qualify for caregiver support services through the Medicaid Alternative Care (MAC) program or through the Tailored Supports for Older Adults (TSOA) program. Limited services under this program may be provided upon completion of a brief eligibility screening. For more information, see Washington Lawhelp.

To find out if you are eligible for MAC or TSOA services, call 1-855-567-0252 or contact your local HCS intake phone number listed above. You may find more information at www.waclc.org.

You may also contact your local Area Agency on Aging (AAA) office. 

Repaying the State for Medical and Long Term Care

By law, the State of Washington may recover the costs it paid for certain types of medical services from your estate through Estate Recovery (RCW 41.05A.090, RCW 43.20B.080, and Chapter 182-527 WAC). Estate Recovery doesn't happen until after your death, and is deferred until the death of your surviving spouse, and your surviving children are age 21 or older. It is also deferred if a surviving child was blind/disabled at your time of death. Recoverable costs include:

• Certain Washington Apple Health long-term services and supports, if you're age 55 or older at the time you received the services;
• Certain state-only funded services, regardless of your age at the time you received the services.

The State may also file a pre-death lien on your real property, at any age, if you become permanently institutionalized (WAC 182-527-2734). The State may recover from a sale of the property, or your estate, unless:

• Your spouse lives at the property.
• Your sibling lives at the property, is a co-owner, and meets certain conditions.
• Your child lives at the property, and is blind/disabled; or
• Your child lives at the property and is younger than age 21.

You can find a list of services subject to cost recovery under WAC 182-527-2742. You can find a list of assets excluded from recovery under WAC 182-527-2746.  Estate Recovery doesn’t apply to services provided under the following Long-term services and support programs:

• Medicaid Alternative Care (MAC)
• Tailored Supports for Older Adults (TSOA)

Race and Ethnic Background Information

Race and Ethnic background information is voluntary and will not affect eligibility or benefit amounts. This information is used to assure program benefits are distributed without regard to race, color, or national origin. For Food Assistance the USDA requires us to answer for you if no information is provided.