GSNAP

Need Help With Your Application?

We can help you submit your application to the Health and Human Services Commission (HHSC). While we’re happy to assist with the process, the NTFB does not determine eligibility. By submitting this form, you are authorizing NTFB to share your information with HHSC so they can determine your eligibility for benefits. If you’re unable to complete the form or need help, please contact our Benefits Call Center at 214-269-0907 or email snap@ntfb.org — we’re here to help!

Here is how the process works

Step 1: Submit an application

The form should take about 20 minutes to complete.

Step 2: Submit proof of your living situation

This includes ID, paystubs, proof of address and expenses. You can do this using the "File Upload" section of this jotform, or within the next 30 days after submitting. You can send in via email at SNAPDocuments@ntfb.org, at your local HHSC office, by fax at 1-877-447-2839 or by mail at HHSC. P.O. Box 149027. Austin, TX 78714-0927.

Step 3. Checking the status of your case

To check the status of your case or an application, you will need to contact 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 case.

Step 4: Processing and determining elegibility

Once the application is submitted, Health and Human services will process and determine eligibility. You will get the response via mail at your mailing address it can take 30-45 days for HHSC to process the application. HHSC gives SNAP food benefits through the Texas Electronic Benefit Transfer (EBT) Lone Star Card. This is a plastic card that's used like a debit card. Each month, your approved monthly benefit amount is placed in the card's account

Disclosure: The North Texas Food Bank is a community partner with Health and Human Services. We will help you fill out your application and submit it to HHSC, but we do not determine eligibility. Eligibility will be determined by Health and Human Services and any correspondence will be sent to your mailing address, NTFB does not receive any information regarding your case.

Important: Please do not miss our call. We will call you to verify the information provided below. This submission will allow North Texas Food Bank to submit your information to Health and Human Services to determine eligibility in the event you do not answer. Please make sure all information is complete. If you have access to a digital platform, such as Zoom or FaceTime and would like virtual assistance in completing your application via yourtexasbenefits.com instead, please call 214-269-0907.
Name*

First NameLast Name
Gender*

MaleFemale
Birth Date*

MonthDayYear
Date
Email
example@example.com
Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is your mailing address the same as your physical?

YesNo
Physical Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What Language do you prefer to speak?
Does anyone in the home have a disability?*

YesNo
What is your Marital Status?*

MarriedSingleDivorcedSeparatedWidowed
What is your race/ethnicity?*

African AmericanAmerican Indian or Alaska nativeAsianHispanic or LatinoNative Hawaiian or Pacific IslanderWhiteOther/Prefer not to answer
Are you a U.S. Citizen?*

YesNo
Are you going to school?*

YesNo
If yes, are you going full - time?*

YesNo
Please mark the benefits anyone on your case is interested in applying for:*

Children's MedicaidMedicaid for an Adult Caring for a ChildSNAP Food BenefitsTANF Cash Help for FamiliesMedicaid for an Adult not Caring for a ChildPregnant Women MedicaidHealthy Texas Women's ProgramTSAP (Texas Simplified Application Project)
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
If so, Name of Person(s) currently working in the home:*
Who is their employer?*
How often do they get paid by their employer?*

DailyWeeklyBiweeklyTwice a MonthMonthlyOther
5. Is there any other type of income that is not from an employer?*

YesNo
If so, Name the Person(s) who receives this income:*
What is the total monthly income received from this?
6. 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
7. Does anyone currently receive cash help, food or health-care benefits from another state?*

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

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

YesNo
If so, what type of place of care:*

Homeless ShelterTemporary living situation of 90 days or less
10. Do you live in Texas and plan to stay in Texas?*

YesNo
If none of the expenses below applies to you, please leave blank or enter 0 in the space provided.
How much do you pay for rent?
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 pay for home insurance or renter's insurance?
How much do you spend on food?
Total Home Costs
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 own's vehicle 1?
How much is owed on vehicle 1?
If you have a second vehicle, please list it's year, make and model here:
Who own's vehicle 2?
How much is owed on vehicle 2?
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 214-269-0907 and complete your application with an NTFB representative.
12. How many people are applying for benefits in your home? If you are a single person household, please select "individual." If you are a family or group household, please select "Other" and put in the comment box how many people are in your family household.*

Individual (1)Other
Person 2 Full Name (Please do not list yourself as person 2, you are person 1):
This person's relationship to you*
Person 2's Date of Birth
Person 2's Gender*

MaleFemale
Person 2's Marital Status*

MarriedSingleDivorcedSeparatedWidowed
Is this person going to school?*

YesNo
Is this person a U.S Citizen?*

YesNo
Is this person a a refugee of legally admitted immigrant?*

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

YesNo
Person 3:
This person's relationship to you*
Person 3's Date of Birth
Person 3's Gender*

MaleFemale
Person 3's Marital Status*

MarriedSingleDivorcedSeparatedWidowed
Is this person going to school?*

YesNo
Is this person a U.S Citizen?*

YesNo
Is this person a a refugee of legally admitted immigrant?*

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

YesNo
Person 4:
This person's relationship to you*
Person 4's Gender*

MaleFemale
Person 4's Date of Birth
Person 4's Marital Status*

MarriedSingleDivorcedSeparatedWidowed
Is this person going to school?*

YesNo
Is this person a U.S Citizen?*

YesNo
Is this person a a refugee of legally admitted immigrant?*

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

YesNo
Person 5:
This person's relationship to you*
Person 5's Date of Birth
Person 5's Gender*

MaleFemale
Person 5's Marital Status*

MarriedSingleDivorcedSeparatedWidowed
Is this person going to school?*

YesNo
Is this person a U.S Citizen?*

YesNo
Is this person a a refugee of legally admitted immigrant?*

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

YesNo
13. 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
14. Does anyone in the home have costs to take care of others (child care, child support, alimony, etc.)?*

YesNo
By signing below, I 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. You do not have to sign this release in order to apply for or receive benefits from HHSC.

Release my 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, I 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.

I certify under penalty of perjury that the information I have provided on this application is true and complete to the best of my knowledge. If it is not, I may be subject to criminal prosecution.
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. Do you plan to file a federal tax return next year?

YesNo
3. Will you file jointly with a spouse?

YesNo
4. Will you claim any dependents on your tax return?

YesNo
5. Will someone claim you as a dependent?

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

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

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

YesNo
If yes, who?
9. 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?
10. Does any child on this application have a parent living outside the home?

YesNo
11. Does anyone get currently get Medicaid, or CHIP?

YesNo
12. Renewing your health coverage in future years. To make it easier to find out if you can get help paying for health coverage in future years, you can agree to allow HHSC to use facts about money you get (income data), including information from tax returns. HHSC will send you a notice, let you make any changes, and you can cancel (optout) at anytime. HHSC 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
TANF Only*

This section is only for children applying for TANF.
1st Child's Full Name:
Father's first and last name:
Father's Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Father's mailing address:
Mother's first and last name:
Mother's maiden name:
Mother's Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Mother's mailing address:
Were these parents ever married to each other?

YesNo
2nd child's name:
Father's first and last name:
Father's Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Father's mailing address:
Mother's first and last name:
Mother's maiden name:
Mother's mailing address:
Mother's Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Were these parents ever married to each other?

YesNo
3rd child's name:
Father's first and last name:
Father's Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Father's mailing address:
Mother's first and last name:
Mother's maiden name:
Mother's mailing address:
Mother's Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Were these parents ever married to each other?

YesNo
4th child's name:
Father's first and last name:
Father's mailing address:
Father's Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Mother's first and last name:
Mother's maiden name:
Mother's mailing address:
Mother's Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Were these parents ever married to each other?

YesNo
Upload documents like proof of income, address verification, and ID here. HHSC uses these to determine eligibility.
Should be Empty:

Need Help With Your Application?

Please answer the following screening questions.

People in the Home

Medicaid Only*

TANF Only*