Get Form 841 - Food Loss Replacement Form ( Rev. 04-20)

Filling out the Form 841 - Food Loss Replacement Form online is a straightforward process designed to assist users in reporting food loss due to unforeseen disasters. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to complete the Form 841 online.

1. Click the ‘Get Form’ button to access the form and open it in your preferred online editor.
2. In the first section, fill in your name using the space provided. This should include your first name, middle initial, and last name.
3. Next, enter your county in the designated field to ensure proper processing of your form.
4. Fill in your complete address in the address section to provide accurate contact information.
5. Input your client identification number (CL ID #) in the corresponding field, as well as your case number (CASE #) to help identify your record.
6. Provide your phone number and email address in the specified fields to ensure you can be reached for any follow-ups regarding your application.
7. Indicate the amount of food your household has lost in the section provided, specifying the total value of the loss.
8. Check the appropriate box to affirm that you used your EBT card to purchase food that was spoiled or lost due to a power outage lasting four hours or more or other property damage caused by a disaster.
9. Certify your statement by providing the date of the disaster in the designated area to validate your claim.
10. Review the penalty warning carefully, acknowledging the consequences of providing false information.
11. Finalize your application by checking the textbox and electronically signing the form by typing your name below.
12. Once you have completed all sections, ensure your information is accurate, then save your changes. You can choose to download, print, or share the completed form as needed.

Complete your form online today to ensure timely assistance for your food loss.