Request for an ADA Accommodation (ADA-1), Request for ADA Accommodation Reconsideration, Central Office Appeal Committee Review Form (ADA-2), Request for Fair Hearing.

Includes notice of appeal rights and form for filing appeal.

DTA paper form used if BEACON breaks down. Most TAFDC and EAEDC applications now taken on screen.

Initial Request for Assistance form for the TAFDC, EAEDC, EA, and FS programs.

DTA flier for clients on Bay State Cap Food Stamps.

DOR Notice to custodial parent of amount of months child support collected.

Form that allows DTA worker to assist client with obtaining verifications from third parties.

Supplment A is a form that a noncitizen parent can use to specify which household members are not applying for benefits and thus do not need to provide proof of immigration or citizenship status.

DTA form to be used by EAEDC applicants applying as disabled individuals. Must be completed by doctor or psychiatrist/psychologist. Updated 9/04.

Note-- this is not the most recent form but can be used. It will be replaced on this website when we get a Spanish version of the new (7/07) English form.

Revised July, 2007.

DTA revised the food stamp application forms and FS change reporting forms to REMOVE the asset questions (no longer required for most households as 
of June 9, 2008). Also available in Spanish and Portuguese in the DTA forms category in the Benefits section of this website.

This FS application form is used by SSA District Offices for "pure" SSI households that do not qualify for Bay State CAP, or who wish to apply for regular food stamps to get expedited or higher FS benefits. SSA offices have an obligation to take FS applications "at any time" and not refer SSI applicants or recipients to the local DTA office. See 7 USC 2020(I). Manchaca v Chater, 927 F. Supp. 962 (E.D. Tex 1996), see also SSA Policy Operations manuarl, Section SI 01801.005.

DTA form for elderly noncitizens to verify disability so as to become eligible for Food Stamps (if they are not otherwise eligible).

Revised medical report form allowing a wide range of medical, mental health, substance abuse providers to sign off indicating an individual is in a voc rehal, mental health, sustance abuse program (and thus exempt from the ABAWD work rules) or has a temporary disability (lasting 30 days or more) that reduces his or her ability to work. This form eliminates a more detailed four page form.

Per Field Operations Memo 2006-53, this separate penalty warning signature page is only to be used to FS applications through SSI and for applicatons over the internet when an interview is subsequently conducted by phone. For all other FS applicants, the penalty warning should be part of the initial application and this additional signature page should be unnecessary.

This brochure was issued as part of Field Operations Memo 2004-34 to specifically advise non-citizens of their right to opt out of a food stamp and TAFDC application if they did not want to give information on their non-citizen status or SSN. Please see Field Ops memo 2004-34 for more information on this.

This brochure was issued as part of Field Operations Memo 2004-34 to specifically advise non-citizens of their right to opt out of a food stamp and TAFDC application if they did not want to give information on their non-citizen status or SSN. Please see Field Ops memo 2004-34 for more information on this.

Instructions for this form were included in Field Operations Memo 2004-34, issued 9/20/04. DTA workers are required to let non-citizens opt out of the TAFDC and food stamp application if they do not want benefits for themselves or do not want to give information on their non-citizen status or SSN. Keep in mind that, for food stamp purposes, a non-citizen who does have work authorization or other legal status may want to give that information even though he or she is not applying since having legal status (either LPR or under color of law status) may trigger higher food stamp benefits using a favorable income calculation.

Instructions for this form were included in Field Operations Memo 2004-34, issued 9/20/04. DTA workers are required to let non-citizens opt out of the TAFDC and food stamp application if they do not want benefits for themselves or do not want to give information on their non-citizen status or SSN. Keep in mind that, for food stamp purposes, a non-citizen who does have work authorization or other legal status may want to give that information even though he or she is not applying since having legal status (either LPR or under color of law status) may trigger higher food stamp benefits using a favorable income calculation.

DTA brochure listing of Massachusetts community organizations that provide advice and representation to immigrants dealing with adjustment of status, deportation, etc. (DTA is planning to revise this list.)

Sample notice announcing possible food stamp overpayment recovery from social security benefits though the TOP system (Treasury Offset Program)

Form for recertification of Food Stamps for people receiving Food Stamps through the Social Security Administration.