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H1855 for Snap Disaster FormForm H1855, Affidavit for
Eligible can be charged with a criminal offense. If convicted the person may be fined imprisoned or both. Signature Head of Household or Responsible Family Member Date. MM/YYYY Replacement Benefits Old Address if applicable Benefit Date MM/YYYY Allotment Amount Original Issuance No. Some of my household s food bought with SNAP benefits was destroyed in a household disaster on The amount destroyed was If this affidavit is not signed and received by the local office within 10 days of the date of...Show details
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