TO:	Commissioners; TA Directors; FS Directors; WMS Coordinators, Staff Development Coordinators, Forms Coordinators

FROM:	Patricia A. Stevens, Deputy Commissioner, Division of Temporary Assistance

SUBJECT:	Introduction of LDSS-4826B: “Interview/Verification Guide for the LDSS-4826: “Food Stamp Benefits Application”

EFFECTIVE DATE:	Immediately

CONTACT PERSON:	Eastern Regional Team at 1-800-343-8859, ext. 3-1469

03 ADM-3, dated February 28, 2003, introduced the simplified, food stamp-only application/recertification form (LDSS-4826).  All local districts are required to offer this form and the “How to Complete” instructions booklet (LDSS-4826A) to households applying only for food stamp benefits.  Effective today, a suggested, non-mandated worker guide (LDSS-4826B: “Interview/Verification Guide for the LDSS-4826”) is now available for use with the new application.  Districts that would like to use this form may download it from the following link and reproduce it locally at this time:

http://sdssnet5/otda/ldss_eforms/eforms/4826B.pdf 

Comments on this form are welcomed and can be forwarded to:

			Carolyn Karins
			NYS OTDA/DTA/Eastern Region Food Stamp Team Leader
			40 N. Pearl St, 11B
			Albany, NY 12243
			(518) 473-1469
			Carolyn.Karins@dfa.state.ny.us