Appendix C: Important DTA Forms and MLRI Charts

DTA Forms

• Request to Choose Someone to be my Authorized Representative
• Request for an Appeal (Fair Hearing)
• DTA Medical Expense Self-Declaration Statement

MLRI Information and Sample Forms

• SNAP Mandatory Verifications Chart
• Links to SNAP Know Your Rights fliers and additional SNAP resources (also below)
• Sample Client Consent Allowing DTA to release Information to Helping Agency
• Sample Client Declaration of Shelter and Dependent Care Costs

MLRI's SNAP Math At a Glance Charts 

• At-a-Glance Chart on SNAP for Working Households
• At-a-Glance Chart for Unemployment Comp Households
• At-a-Glance Chart for 1 and 2 Persons Elder/Disabled Households
• SNAP Benchmarks Chart for Claiming Medical Expenses

SNAP Know Your Rights fliers and additional SNAP resources

ABAWD fliers and information: MassLegalServices.org/ABAWD

SNAP Medical Expense Deduction, including Know Your Rights flier (English and Spanish) and rent calculation worksheet toolkit: MassLegalServices.org/SNAP-medical

College Students and SNAP, including Know Your Rights fliers and a 3 minutes video: Masslegalservices.org/food4students

Veterans Outreach Fliers: Masslegalservices.org/SNAP4veterans

SNAP Know Your Rights Fliers:

• Household Misfortune/Replacement SNAP: MassLegalServices.org/SNAPMisfortune
• SNAP and Strikers (English and Spanish): Masslegalservices.org/SNAPandstrikers
• SNAP and Dependent Care Expenses: Masslegalservices.org/SNAPdependentcare
• Adult Foster Care: Masslegalservices.org/content/adult-foster-care-and-snap
• Foster Care (children): Masslegalservices.org/content/foster-care-families-and-snap

Authorized Representatives vs. Helping Agencies: Masslegalservices.org/content/helping-agency-vs-authorized-representative 

EDSAP Overview: Masslegalservices.org/EDSAP

SNAP and the National School Lunch Program – Household Composition and Income Flier: Masslegalservices.org/NSLPvsSNAPincome

Added Benefits of SNAP flier (in 5 languages): Masslegalservices.org/addedbenefitsofSNAP

Public Charge Information: MassLegalServices.org/PublicCharge

SNAP calculators: Masslegalservices.org/content/food-stamps-snap-calculators