DTA Request for Authorized Representative/Rep Payee Image-10

ALERT:  Do NOT use the "Authorized Rep/Rep Payee Form" if you are a legal representative or a social services agency and are  helping a client find out the status of their case, fix a  closed or denied SNAP or cash case problem. We recommend you use a "Permission to Access DTA Case Record" form for that purpose.  The client can also hand write a statement with the same information on it and fax that to DTA as well. Permission to talk with DTA or access case information need NOT be on a specific form. 

The DTA "Authorized Representative/Rep Payee Forms" are generally used to appoint a relative, friend or a social services agency to act in the place of the applicant or recipient to fill out and legally sign the application, such as a legal guardian or substance abuse program or group home. A SNAP or cash recipient has the right to appoint someone to help them with the application and recertification (e.g. the authorized rep gets the notices for interviews, approval notices, recertifications) as well as received the EBT card and manage the SNAP or cash benefits. The Rep Payee or Authorized Rep will also be asked for his or her SSN and other identifying information if acting in this legal/financial management capacity.  

A SNAP or cash household can also limit the role of the "authorized representative/rep payee" to a specific function (such as helping with application but not getting an EBT card).  In addition, the SNAP or cash assistance household has the right to retain their own EBT card while the authorized representative gets a separate second EBT card (in his or her name) for the same EBT benefits account.  This can be important for SNAP or cash recipients who wish to keep track of their benefits and/or manage their funds along with a helping person. Be sure DTA does not deactivate the recipient's EBT card if an authorized representative is appointed, unless the recipient choses to have no involvement in their benefits. (Some exceptions to this apply for residents of drug or alcohol treatment programs).  

• English Request for Authorized Representative- Authorized Agency-Authorized Payee Image-10
• Spanish Solicitud por Representante Autorizado – Agencia Autorizado – Pagador Autorizado  Image-10 (S)

Click the "Go to Website" link below for the forms included in DTA's Online Guide.