Monthly report form
(2) Monthly report form. The State agency's monthly report form shall meet the following requirements: (i) Be written in clear, simple language; (ii) Meet the bilingual requirements described in 272.4(b) of this chapter; (iii) Specify the date by which the agency must receive the form and the consequences of a late or incomplete form, including whether the State agency shall delay payment if the form is not received by the specified date; (iv) Specify the verification which the household must submit with the form, in accordance with 273.21(i); (v) Identify the individual or agency unit available to assist in completing the form: (vi) Include a statement to be signed by a member of the household (in accordance with 273.2(c)(7) regarding acceptable methods of signature), indicating his or her understanding that the provided information may result in changes in the level of benefits, including reduction and termination; (vii) Include, in prominent and boldface lettering, an understandable description of the Act's civil and criminal penalties for fraud. (viii) If the form requests Social Security numbers, include a statement of the State agency's authority to require Social Security numbers (SSN's) (including the statutory citation, the title of the statute, and the fact that providing SSN's is mandatory), the purpose of requiring SSN's, the routine uses for SSN's, and the effect of not providing SSN's. This statement may be on the form itself or included as an attachment to the form. (3) Reported information. The State agency may determine the information relevant to eligibility and benefit determination to be included on the monthly report form except that the State agency shall not require households to monthly report medical expenses. Medical expenses may be reported in accordance with 273.10(d)(4). (4) Combined form. If the State agency uses a combined monthly report for SNAP benefits and TANF, the State agency shall clearly indicate on the form that non-TANF SNAP households need not provide TANF-only information. (i) Verification. Each month the household shall verify information for those items designated by the State agency. The State agency may designate that verification be submitted for any item that has changed or appears questionable. If the household voluntarily reports a change in its medical expenses, the State agency shall verify the change in accordance with 273.2(f)(8)(ii) before acting on it if the change would increase the household's allotment. In the case of a reported change that would decrease the household's allotment, or make the household ineligible, the State agency shall act on the change without requiring verification, though verification which is required by 273.2(f)(8)(i) shall be obtained prior to the household's recertification.