Follow the steps to fill out the form successfully.

1. Click the ‘Get Form’ button to access the form and open it in your preferred editor.
2. In Section 1, indicate if you want someone to represent you in applying for benefits or acting on your behalf. Ensure you select the specific function(s) you are authorizing the representative to perform. Each authorized representative needs their own completed form.
3. Move to Section 2 and print the name of your chosen representative clearly. Then, select the relationship they have with you from the options provided, such as friend or family member.
4. Next, fill in the representative's mailing address, including the number and street, city, state, and ZIP code.
5. Select the specific functions you are authorizing your representative to perform by checking the appropriate boxes in the function section. Functions include signing applications, reporting changes, and receiving benefits. If applicable, complete additional information for the Electronic Benefits Transfer (EBT).
6. In this section, both you and your representative must sign and date the form to affirm the agreement. Make sure the signatures are clear and the dates are correct.
7. Finally, review your completed form for accuracy. Once satisfied, you can save the changes, download, print, or share the form as needed.

Complete the Authorized Representative for Snap and Cash Assistance form online today!