PM 19-03-06

Depending upon the specific case situation (see WAG 01-06-07), use the following forms (as outlined in WAG 19-03-03-c) when the SNAP REDE is approved or denied.

  • Form 157C;
  • Form 360 series;
  • Form 360A; or
  • Form 360C.
  • Form 552

    Used to register applications and to deny or approve SNAP benefits for applications through intake that are not processed through the AIS. 

  • Application for SNAP (Form 683)

    Completed by all SNAP units in lieu of the centrally mailed Form 1893 except for EZ REDE units when reapplying for SNAP as part of the REDE process. 

  • SNAP Eligibility Worksheet (Form 683A)

    Except for SNAP REDEs processed through AIS, complete Form 683A. Complete Form 683A for SNAP REDEs received through the Phone System Interview.  File Form 683A in the case record. 

  • SNAP Calculation Sheet (Form 683B)

    Complete Form 683B to determine the benefit amount for each SNAP REDE not processed through ACM or AIS. Submit Form 552 with the correct income, need, and (if applicable) asset amounts. File Form 683B in the case record.

    The ACM SNAP calculation printout may be used in place of the Form 683B for cases processed through ACM. revised textSave the ACM calculation in Content Mangement.

  • Summary of Case Information (Form 1376/Form 1376C)

    The manual Summary of Case Information (Form 1376), when used with Form 552, gives a complete summary of case information.

    The form contains essential information as well as verifications not likely to change. The forms serve as an overview of eligibility factors. See WAG 26-01-01-a for completion of Form 1376.

    The automated Summary of Case Information (Form 1376C), when used with Form 552, gives a complete summary of case information. AIS generates a Form 1376C for each regular roll (Option 8) approval after the "Actions To Be Taken Screen." 

  • SNAP Redetermination Application (Form 1893)

    Centrally produced REDE application and notice of expiration mailed to specific SNAP units authorized on the regular roll added text, including EZ REDE cases due for a face-to-face interview and not entitled to use PSI. 

  • Your SNAP Benefits Are Ending (Form 4893)

    Centrally produced notice of expiration mailed to SNAP units that have the option of completing their face-to-face REDE using the Phone System Interview.

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  • Redetermination Application (Form 4765/Form 4764)

    REDE application completed by SNAP units in EZ REDE status. Form 4765/4764 is centrally sent for the alternating mail-in REDE and given to the unit at the face-to-face REDE. 

  • Attachment to Redetermination (Form 4765B)

    Attachment to EZ REDE application. Send or give to EZ REDE units that are locally sent Form 4765. 

  • Redetermination Fact Sheet (Form 4769)

    Form 4769 is provided to EZ REDE units to notify them of their Gross Income Eligibility Standard for the new approval period. 

After you make a final eligibility decision, file all SNAP REDE verification documents, the SNAP REDE application (Form 683, Form 1893, or Form 4765), and Form 4143 in the case record. If the FS unit is eligible, authorize benefits (see WAG 19-03-03-a).