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04/01/13

Summary:

  • Effective 04/01/13, Form 3162, Attachment to Application Declaration Regarding Citizenship/Alien Status is obsolete.
  • To comply with Administrative Directive 01.01.01.190-Identity Protection Act, the information contained in the Statement of Identity Protection Purpose, Form IL444-0026 is now included in the Rights and Responsibility page and is no longer required for applications for cash, medical or SNAP benefits. 
  • At the request of FCRC staff, the wording of Form 3162, Attachment to Application Declaration Regarding Citizenship/Alien Status has been added to the Rights and Responsibility page of Form 2378b, Request for Cash Assistance-Medical Assistance-Supplemental Nutrition Assistance Program (SNAP), Form 2378C (AIS), Form 683, Application for the Supplemental Nutrition Assistance Program (SNAP) and Form 243, Request for Assistance for Additional Family Member. 
  • The Rights and Responsibility screens for the DHS Web Benefits Online Application has been revised to include the wording from Form 3162, Attachment to Application Declaration Regarding Citizenship/Alien Status.
  • Additional definitions of SNAP trafficking penalties have been added to the Penalty Warning of the SNAP Rights and Responsibility pages. 
  • Use Equifax (The Work Number) as a source to verify earned income. 

Citizen/USCIS Status Declaration

Every applicant for cash or SNAP must state in writing, under penalty of perjury, whether he or she is a U.S. citizen or a noncitizen. 

The declaration is signed under penalty of perjury and is included in the Rights and Responsibility page of the application, Form 2378b, Request for Cash Assistance-Medical Assistance-Supplemental Nutrition Assistance Program (SNAP), Form 2378C (AIS) and Form 683, Application for the Supplemental Nutrition Assistance Program (SNAP). The signed signature page is a condition of eligibility for both citizens and noncitizens.

The Rights and Responsibility screens for the DHS Web Benefits Online Application has been revised to include the wording from Form 3162, Attachment to Application Declaration Regarding Citizenship/Alien Status.

Form 243, Request for Assistance for Additional Family Member has been revised to include the Declaration Regarding Citizenship/Alien Status.

NOTE: Noncitizens applying only for their citizen children do not have to provide information or proof of their own USCIS status.

Noncitizens (other than undocumented children for medical) who do not want to give proof of their United States Citizenship and Immigration Services (USCIS) status do not qualify for benefits. Do not ask these persons for proof of their USCIS status. Do not report these ineligible noncitizens to USCIS. Do not deny or cancel the rest of the case due to a person's refusal to give proof of their USCIS status.

Continue to obtain Form 2781, Attachment to All SNAP Applications for all SNAP applications completed in AIS or if the application was submitted from the Illinois DHS Web Benefits Online Application.

Identity Protection Act

It is the policy of the Department of Human Services (DHS) to ensure the confidentiality and integrity of Social Security Numbers (SSNs) that are collected, maintained and used in the course of DHS business as outlined in the Identity Protection Act. DHS will implement practices to safeguard SSNs against unauthorized access to guard against the facilitation of identity theft and to ensure confidentiality in compliance with the Identity Protection Act and other local, State and federal laws.

Whenever a DHS employee or DHS requests a Social Security Number (SSN), DHS shall provide a statement of the purpose or purposes for which DHS is collecting and using the SSN.  The statement of the purpose for collecting and using the SSN is incorporated into the Rights and Responsibility pages of the application. 

SNAP Penalty Warning

As a result of USDA Food and Nutrition Service (FNS) finalization of a rule addressing SNAP penalties and continued emphasis on recipient integrity, additional definitions of SNAP trafficking have been added to the SNAP Penalty Warning.

The buying, selling, or stealing SNAP benefits or reselling food bought with SNAP benefits is considered trafficking and may result in disqualification from the SNAP program. 

The Work Number

Equifax (The Work Number)  is an available source to verify earned income.  If The Work Number is used to verify earned income, document and file the verification in the case record.

MANUAL REVISIONS

Form referenced:

  • Form IL 444-0026
  • Form 243
  • Form 683
  • Form 2378b
  • Form 2781
  • Form 3162 (obsolete)

[signed copy on file]

Michelle R. B. Saddler

Secretary, Illinois Department of Human Services