Thank you for referring your neighbor to the SSA team for benefits assistance!

Need Help with Your Application?
The North Texas Food Bank can help you complete and submit your application to the Health and Human Services Commission (HHSC). While we’re happy to assist with the process, NTFB does not determine eligibility. If you’re unable to complete the form or need help, please contact our Benefits Call Center at 214-269-0906 or email snap@ntfb.org — we’re here to help!

How the process works

Step 1: Submit your information

On the next page, submit your information. The form should take about 10 minutes to complete. You will have the opportunity to submit your verification items such as ID, paystubs, proof of address and expenses at the end of the form or can do so when speaking with the North Texas Food Bank navigator.

Step 2: North Texas Food Bank will contact you by phone.

The North Texas Food Bank will contact you to review your application with you over the phone or virtually. We will call you from 214-269-0906.

Important: If you do not answer, we will submit your application as is.

Step 3. Checking the status of your application

To check on the status of your application, you may contact Health and Human Services by calling 211, or (877) 541-7905.

Once you are connected, you will select your preferred language, then select option 2 for assistance with state benefits and let the virtual assistance know you want to "check the status" of your application.

Step 4: Processing and determining eligibility

Once the application is submitted Health and Human Services will process and determine eligibility. You will get the response by mail to your mailing address.

It can take 30-45 business days for HHSC to process your application.

If approved, HHSC gives SNAP food benefits through the Texas Electronic Benefit Transfer (EBT) Lone Star Card. This is a plastic card that is used like a debit card. Each month, your approved monthly benefit amount is placed in the card's account and is valid at most grocery stores and convenience stores.

Disclosure: The North Texas Food Bank does not determine eligibility. Eligibility will be determined by Health and Human Services.

Virtual Site Inquiry Submission

Important: Please do not miss our call. NTFB will call you to review your application with you. If you miss our call, the application will be submitted as is. If you are unable to complete the following submission, please contact 214-269-0906.
Please select the agency who referred you to us:*
Name of Referring Agency:*
Name*

First NameLast Name
Date of Birth*
Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Home Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
What is your race/ethnicity?*

African AmericanAmerican Indian or Alaska nativeAsianHispanic or LatinoNative Hawaiian or Pacific IslanderWhiteOther/Prefer not to answer
Marital Status*

MarriedSingleDivorcedSeparatedWidowed
Are you a U.S. Citizen?*

YesNo
Social Security (you can provide this later to Health and Human Services but is helpful when checking the status of your application):
If you are not a U.S. Citizen, are you a refugee or legally admitted immigrant?*

YesNo
Gender*

MaleFemale
Are you going to school?*

YesNo
If yes, are you going full time?*

YesNo
What language do you prefer to speak?
Please mark the benefits anyone on your case is interested in applying for:*

SNAP Food BenefitsTANF Cash Help for FamiliesChildren's MedicaidMedicaid for an Adult Caring for a ChildMedicaid for an Adult not Caring for a ChildPregnant Women MedicaidHealthy Texas Women's Program
Please answer the following screening questions.
1. Is anyone in the home a migrant worker or seasonal farmworker?*

YesNo
2. Does anyone in the home have money in the bank?*

YesNo
If so, how much:*
3. Does anyone in the home expect to receive money this month? (This includes money you get from jobs, child support, social security and unemployment)*

YesNo
What is your total monthly income?*
4. Does anyone in the home receive income from a job?*

YesNo
Name of Person(s) currently working:*
Who is their employer?*
How often do they get paid by their employer?*

DailyWeeklyBiweeklyTwice a MonthMonthlyOther
5. Does anyone in the home pay costs for housing and utilities? (This includes rent, mortgage, water, gas, electric, sewage, trash, phone and property tax)*

YesNo
How much do you pay for rent?
How much do you pay for home insurance/renter's insurance?
How much do you pay for water?
How much do you pay for electricity (light)?
How much do you pay for natural gas?
How much do you pay for your phone?
How much do you spend on food?
Total Home Costs
6. Does anyone currently receive cash help, food or health-care benefits from another state?*

YesNo
7. Has anyone been convicted of a felony for conduct that: (1) took place after August 22, 1996, and (2) involved illegal drugs?*

YesNo
If yes, who?
8. Is anyone living in a place of care such as homeless shelter, drug treatment center or a group home?*

YesNo
If yes, who?
If yes, what type of place of care?

Homeless ShelterFamily Violence CenterDrug Treatment CenterTemporary living situation of 90 days or less
9. Do you live in Texas and plan to live in Texas?*

YesNo
10. When people break program rules, they are sometimes "disqualified" from getting benefits. Is anyone living with you disqualified from getting cash help or food benefits anywhere in the United States?*

YesNo
11. Does anyone own or is anyone paying for a car, truck, boat, motorcycle?*

YesNo
If yes, please list vehicle's year, make and model:*
Who owns this vehicle?
How much is owed on the vehicle?
Is there another vehicle in the home?

YesNo
What is the second vehicle's year, make and model:*
Who owns this vehicle?
How much is owed on the vehicle?
Is there another vehicle in the home?

YesNo
What is the third vehicle's year, make and model:*
Who owns this vehicle?
How much is owed on the vehicle?
People in the Home

Please list the people in your home and their relationship to you. Document first and last name. If there is not enough space, please call 214-269-0906 and complete your application with an NTFB representative.
How many people are in your home?*
Full Name of Person 2 in your home (you are person 1):
This person's relationship to you:*
Date of Birth for Person 2:*

MonthDayYear
Gender for Person 2:*

MaleFemale
What is their race/ethnicity?*

African AmericanAmerican Indian or Alaska nativeAsianHispanic or LatinoNative Hawaiian or Pacific IslanderWhiteOther/Prefer not to answer
Marital Status for Person 2:*

MarriedSingleDivorcedSeparatedWidowed
Is Person 2 in school?*

YesNo
If yes, is this person going full-time?*

YesNo
Is Person 2 a U.S. Citizen?*

YesNo
Social Security (you can provide this later to Health and Human Services but is helpful when checking the status of your application):
Is Person 2 a refugee or legally admitted immigrant?*

YesNo
Does this person live in Texas and plan to stay in Texas?*

YesNo
Full Name of Person 3:
This person's relationship to you:*
Date of Birth for Person 3:*

MonthDayYear
Gender for Person 3:*

MaleFemale
What is their race/ethnicity?*

African AmericanAmerican Indian or Alaska nativeAsianHispanic or LatinoNative Hawaiian or Pacific IslanderWhiteOther/Prefer not to answer
Marital Status for Person 3:*

MarriedSingleDivorcedSeparatedWidowed
Is Person 3 in school?*

YesNo
If yes, is this person going full-time?*

YesNo
Is Person 3 a U.S. Citizen?*

YesNo
Social Security (you can provide this later to Health and Human Services but is helpful when checking the status of your application):
Is Person 3 a refugee or legally admitted immigrant?*

YesNo
Does this person live in Texas and plan to stay in Texas?*

YesNo
Full Name of Person 4:
This person's relationship to you:*
Date of Birth for Person 4:*

MonthDayYear
Gender for Person 4:*

MaleFemale
What is their race/ethnicity?*

African AmericanAmerican Indian or Alaska nativeAsianHispanic or LatinoNative Hawaiian or Pacific IslanderWhiteOther/Prefer not to answer
Marital Status for Person 4:*

MarriedSingleDivorcedSeparatedWidowed
Is Person 4 in school?*

YesNo
If yes, is this person going full-time?*

YesNo
Is Person 4 a U.S. Citizen?*

YesNo
Social Security (you can provide this later to Health and Human Services but is helpful when checking the status of your application):
Is Person 4 a refugee or legally admitted immigrant?*

YesNo
Does this person live in Texas and plan to stay in Texas?*

YesNo
Full Name of Person 5:
This person's relationship to you:*
Date of Birth for Person 5:*

MonthDayYear
Gender for Person 5:*

MaleFemale
What is their race/ethnicity?*

African AmericanAmerican Indian or Alaska nativeAsianHispanic or LatinoNative Hawaiian or Pacific IslanderWhiteOther/Prefer not to answer
Marital Status for Person 5:*

MarriedSingleDivorcedSeparatedWidowed
Is Person 5 in school?*

YesNo
If yes, is this person going full-time?*

YesNo
Is Person 5 a U.S. Citizen?*

YesNo
Social Security (you can provide this later to Health and Human Services but is helpful when checking the status of your application):
Is Person 5 a refugee or legally admitted immigrant?*

YesNo
Does this person live in Texas and plan to stay in Texas?*

YesNo
Full Name of Person 6:
This person's relationship to you:*
Date of Birth for Person 6:*

MonthDayYear
Gender for Person 6:*

MaleFemale
What is their race/ethnicity?*

African AmericanAmerican Indian or Alaska nativeAsianHispanic or LatinoNative Hawaiian or Pacific IslanderWhiteOther/Prefer not to answer
Marital Status for Person 6:*

MarriedSingleDivorcedSeparatedWidowed
Is Person 6 in school?*

YesNo
If yes, is this person going full-time?*

YesNo
Is Person 6 a U.S. Citizen?*

YesNo
Social Security (you can provide this later to Health and Human Services but is helpful when checking the status of your application):
Is Person 6 a refugee or legally admitted immigrant?*

YesNo
Does this person live in Texas and plan to stay in Texas?*

YesNo
Full Name of Person 7:
This person's relationship to you:*
Date of Birth for Person 7:*

MonthDayYear
Gender for Person 7:*

MaleFemale
What is their race/ethnicity?*

African AmericanAmerican Indian or Alaska nativeAsianHispanic or LatinoNative Hawaiian or Pacific IslanderWhiteOther/Prefer not to answer
Marital Status for Person 7:*

MarriedSingleDivorcedSeparatedWidowed
Is Person 7 in school?*

YesNo
If yes, is this person going full-time?*

YesNo
Is Person 7 a U.S. Citizen?*

YesNo
Social Security (you can provide this later to Health and Human Services but is helpful when checking the status of your application):
Is Person 7 a refugee or legally admitted immigrant?*

YesNo
Does this person live in Texas and plan to stay in Texas?*

YesNo
Full Name of Person 8:
This person's relationship to you:*
Date of Birth for Person 8:*

MonthDayYear
Gender for Person 8:*

MaleFemale
What is their race/ethnicity?*

African AmericanAmerican Indian or Alaska nativeAsianHispanic or LatinoNative Hawaiian or Pacific IslanderWhiteOther/Prefer not to answer
Marital Status for Person 8:*

MarriedSingleDivorcedSeparatedWidowed
Is Person 8 in school?*

YesNo
If yes, is this person going full-time?*

YesNo
Is Person 8 a U.S. Citizen?*

YesNo
Social Security (you can provide this later to Health and Human Services but is helpful when checking the status of your application):
Is Person 8 a refugee or legally admitted immigrant?*

YesNo
Does this person live in Texas and plan to stay in Texas?*

YesNo
Full Name of Person 9:
This person's relationship to you:*
Date of Birth for Person 9:*

MonthDayYear
Gender for Person 9:*

MaleFemale
What is their race/ethnicity?*

African AmericanAmerican Indian or Alaska nativeAsianHispanic or LatinoNative Hawaiian or Pacific IslanderWhiteOther/Prefer not to answer
Marital Status for Person 9:*

MarriedSingleDivorcedSeparatedWidowed
Is Person 9 in school?*

YesNo
If yes, is this person going full-time?*

YesNo
Is Person 9 a U.S. Citizen?*

YesNo
Social Security (you can provide this later to Health and Human Services but is helpful when checking the status of your application):
Is Person 9 a refugee or legally admitted immigrant?*

YesNo
Does this person live in Texas and plan to stay in Texas?*

YesNo
Full Name of Person 10:
Date of Birth for Person 10:*

MonthDayYear
Gender for Person 10:*

MaleFemale
What is their race/ethnicity?*

African AmericanAmerican Indian or Alaska nativeAsianHispanic or LatinoNative Hawaiian or Pacific IslanderWhiteOther/Prefer not to answer
Marital Status for Person 10:*

MarriedSingleDivorcedSeparatedWidowed
Is Person 10 in school?*

YesNo
If yes, is this person going full-time?*

YesNo
Is Person 10 a U.S. Citizen?*

YesNo
Social Security (you can provide this later to Health and Human Services but is helpful when checking the status of your application):
Is Person 10 a refugee or legally admitted immigrant?*

YesNo
This person's relationship to you:*
Does this person live in Texas and plan to stay in Texas?*

YesNo
12. Does anyone in the home have a disability?*

YesNo
If yes, who?*
13. Is anyone an active duty member of one of these military forces? • U.S. Armed Forces • National Guard • Reserves • State Military Forces

YesNo
14. Is anyone a veteran, including being discharged or released from military service?

YesNo
By signing below, you agree:

To let HHSC and other state, federal, and local agencies check, share, and get facts about anyone on my benefits case (the household).

To let other people, businesses, and organizations share facts they have about anyone on my benefits case (the household) with HHSC.

The facts to be checked and shared include anything that helps decide: (1) who can get benefits, and (2) the amount of benefits.

By signing, you are giving the Texas Health and Human Services Commission (HHSC) permission to release all or part of your case record, which may also include health information.

Release your information to the following person/agency:

North Texas Food Bank: 3677 Mapleshade Ln., Plano, TX 75075 and/or 4500 S. Cockrell Hill Rd., Dallas, TX 75236 | Phone: 214-269-0906

By signing below, you agree:

To let HHSC and other state, federal, and local agencies check, share, and get facts about anyone on my benefits case (the household).

To let other people, businesses, and organizations share facts they have about anyone on my benefits case (the household) with HHSC.

The facts to be checked and shared include anything that helps decide: (1) who can get benefits, and (2) the amount of benefits.

You certify under penalty of perjury that the information you have provided on this application is true and complete to the best of your knowledge. If it is not, you may be subject to criminal prosecution.

By signature, you consent to the North Texas Food Bank (“NTFB”) collecting, retaining, and storing my data for purposes related to its assistance with public benefit programs, as well as its mission. You understand that your data may be used for program administration, service coordination, data analysis, research, reporting, and other activities that help NTFB improve programs and measure impact. NTFB may share data with partners, funders, and authorized agencies for these purposes. Your personal information will not be sold or used for commercial purposes, and NTFB will take reasonable steps to protect your privacy and data security. You understand that you can revoke this consent at any time.
Signature*
Date

MonthDayYear
Date
Medicaid Only*

Fill out this section only if the amount of money you get changes or might change from month to month. If you don’t expect changes to your monthly income, skip this question.
Your total income this year
1. Can anyone listed on this form get health insurance through a job? Check yes even if the coverage is from someone else's job, such as a parent or spouse.

YesNo
2. Did anyone have insurance through a job and lose it within the past 3 months?

YesNo
If yes, who?
3. Is anyone who is applying for health coverage in jail(incarcerated)?

YesNo
If yes, who is in jail?
If yes, who?
5. Is anyone in the home pregnant?*

YesNo
If yes, who is pregnant?*
Number of babies expected
Is this your first pregnancy?*

YesNo
What is the first and last name of the unborn child's father?
6. Renewing your health coverage in future years. To make it easier to find out if I can get help paying for health coverage in future years, I agree to allow the agency to use facts about money I get (income data), including information from tax returns. The agency will send me a notice, let me make any changes, and I can cancel (optout) at anytime. I agree: Yes, the agency can get facts listed above and renew my health coverage without asking me for the next:

5 years4 years3 years2 years1 yearDon't use information from tax returns to renew my coverage.
Signature*
Date

MonthDayYear
Date
File Upload - HHSC requires proof of income, address, expenses and IDs. If you would like to submit that information now, please click below.

Cancelof
Type a question

yes
Should be Empty:

Virtual Site Inquiry Submission

Please answer the following screening questions.

People in the Home

Medicaid Only*