fsst10-23N.xls - NJ Department of Human Services Extranet Business by xiuliliaofz


									What are Food Stamps?
The purpose of the Food Stamp Program is to improve nutrition and health. It helps low income
households buy the food they need for a nutritionally adequate diet. The program is authorized by
Congress and is State supervised and administered by the local county welfare agency.
How to apply...
The application process includes completing and filing an application form, a face to face interview with
the head of household or a designate, and verification of information on the application. Applications
may be filed in person, faxed, by mail or through an authorized representative. Expedited service is
available to households that meet specific criteria. Households in which all members are applicants for
or recipients of SSI, may apply for Food Stamps at the Social Security District office at the same time
you apply for SSI.

What is the Food Stamp Screening Tool?
This tool allows you to enter some very basic eligibility requirements for the Food Stamp Program,
calculates your possible eligibility for Food Stamps and provides you with an estimated Food Stamp
Who created it?
The Food stamp tool was developed by Mercer Street Friends in conjuction with Mercer County Board
of Social Services. Recently, these organizations generously donated this tool for NJ Department of
Human Services in order to make it accessible to the residents of New Jersey.
Where to apply? Just select your county:           -- None --
3/3/2011                          Estimated Food Stamp Benefit

                                     ENTER SUMMARY PAGE INFORMATION

                                             Are you or any member of your Food Stamp
                    Check       No       Yes Household, age 60 (and Older), or Disabled and are
                                     1       living and sharing meals with you

                 Enter               0      Number Of Dependent Children Under Age 2
                                     0      Number Of Dependent Children Age 2 and Older
                                     0      Number of Additional Family Members
                                     1      # of FS Members

                                            Monthly Gross Earnings. (Earnings before taxes or
                 Enter            $0        before any deductions are taken)
                                            Unearned Income. (Such as TANF/General Assistance,
                 Calculate        $0        SSI, Child Support etc.)
                                  $0        Standard Deduction is $134 for a family size of 1

                 Calculate        $0        Medical Expenses
                                  $0        Dependent Care

                 Enter            $0        Other Deductions (child support payment, etc.)

                 Calculate        $0        Excess Shelter Costs

                                  $0        NET ADJUSTED INCOME

                                 $141       FOOD STAMP BENEFIT

                                               Version has expired! Get the latest at
           Select County:      -- None --                       DISCLAIMER

      Please note the Food Stamp amount calculated by this program is intended to be an
      ESTIMATE of Food Stamp benefits for your household. This amount is
      based on the accuracy and completeness of the information inputted. The
      actual amount of your Food Stamps may be different when you present
      verified information and all appropriate Food Stamp regulations are applied.
TANF Grant                             $0
Social Security (Gross)                $0
Veterans Benefits (VA)                 $0
Pension                                $0
Supplemental Security Income (SSI)     $0
General Assistance Grant               $0
Unemployment Insurance Benfits (UIB)   $0
Contributions                          $0
Student Income                         $0
Other                                  $0

TOTAL                                  $0
Medical & Dental                         $0    Math Helper
Hospital or Nursing                      $0
Health Insurance                         $0          How Often?
Medicare                                 $0
Drugs (PRES.)                            $0
Dentures                                 $0          How Much?
Hearing Aids                             $0
Eyeglasses                               $0
Medical Transportation                   $0    Monthly Amount:
Nurse Services                           $0
Other                                    $0

TOTAL                                    $0

Monthly Medical expenses in excess
of $35 if age 60 and older or disabled    $0
Adjusted Gross Income                    $0

       Annually   1    1   4.33300   Weekly
                       2   2.16700   Bi-Weekly
                       3   0.33330   Quarterly
                  $0   4   0.16667   Bi-Annually
                       5   0.08333   Annually


Rent or Mortgage                            $0
                                                                                 Math Helper
Property Tax                                $0
                                                                                       How Often?
Home Owners Insurance                       $0

                                                                                       How Much?
Limited Utility Allowance (LUA) ($156 allowance)
For Households that pay 2 utilities not including heating or
cooling                                                                          Monthly Amount:
Heating & Cooling Standard Utility Allowance (HCSUA) ($250 allowance)
For Households that pay for heating or cooling
Single Utility (Actual amount Paid)
Households that pay one (1) utility other than (excluding) heating or cooling.

Please select the utility allowance which applies to your household
               Single Utility   =           $0

TOTAL                                       $0
Less 50% of Adjusted Gross
Income of $0 equals                         $0
Excess Shelter Costs                        $0

                                    4         1
Math Helper

      How Often? Weekly   1    2   1   4.33300   Weekly
                                   2   2.16700   Bi-Weekly
                                   3   0.33330   Quarterly
      How Much?           $0       4   0.16667   Bi-Annually
                                   5   0.08333   Annually

Monthly Amount:           $0

In Home Baby Sitting                              $0                         Math Helper

Day Care Costs (excluding Vouchers)               $0                               How Often?

Before or After School                            $0
                                                                                   How Much?

                                                                              Monthly Amount:

Other                                             $0

TOTAL OF ACTUAL COSTS                             $0            You have not entered any dependents on the Sum
                                                                Click on - Return to Summary Page - to enter num

The Maximum Dependant Care allowance is         $0
Your maximum dependent care is calculated at $200 per child under the age of 2 and $175 per child over the age of

            Weekly   1             2   1   4.33300   Weekly
                                       2   2.16700   Bi-Weekly
                                       3   0.33330   Quarterly
                     $0                4   0.16667   Bi-Annually
                                       5   0.08333   Annually

ed any dependents on the Summary Page.
 Summary Page - to enter number of dependents

$175 per child over the age of 2
County   Agency   Street   City   State   Zip   Telephone

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