Requirements

  • SNAP benefit theft must have occurred between October 1, 2022, and September 30, 2024.
  • The household may not receive more than two replacement issuances for stolen benefits in a federal fiscal year.
  • The household must have reported stolen benefits to DHS within 30 days of discovering the theft.
  • The request must be made by the head of household, an adult household member, or an authorized representative listed on the case.

ATTESTATION
I understand the following:

  • I must complete, submit, and sign the Request for Replacement of Stolen SNAP Benefits form to request the replacement of stolen benefits.
  • The information I provide in this request is true and accurate.
  • The submission of this request does not guarantee that my benefits will be replaced.
  • If I knowingly give incorrect information about the facts stated in the Request for Replacement of Stolen SNAP Benefits form, I may be charged with an Intentional Program Violation (IPV) and may be subject to civil and criminal penalties including, but not limited to, perjury for a false claim.
Sign above

Once you have read and signed the above Attestation, the request form will appear below.

If you need help reading, completing this document or communicating with us, call 1-877-423-4746. Our services, including interpreters, are free. If you are deaf, hard-of-hearing, deaf-blind, or have difficulty speaking, you can call us at the number above by dialing 711 (Georgia Relay).

This form must be used to request the replacement of SNAP benefits that were stolen through skimming, cloning, phishing, or other similar fraudulent methods.

A. Household Information

Address:

B. Benefit Theft Information

*If you selected "no," a card will be ordered on behalf of the household if replacement benefits are approved.

Please list the transactions that were not made by you:

To report additional transactions, please download the Additional Transaction Sheet and upload it here once complete.
One file only.
256 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, xls, xlsx, csv.

C. Certification

I understand and agree to the following:

  • I must complete, sign, and submit this form to request the replacement of stolen benefits.
  • The information I provided in this request is true and accurate, to the best of my knowledge.
  • The submission of this request does not guarantee that my benefits will be replaced.
  • If I have knowingly given incorrect information about the facts stated above, I may be charged with an intentional program violation (IPV) and may be subject to civil and criminal penalties including, but not limited to, perjury for a false claim.
  • I have a right to a fair hearing to contest the denial or replacement issuance amount for my household. Replacements would not be issued pending the fair hearing decision.
Sign above
I have read and understand the Notice of ADA/Section 504 Rights.

Note: If you reported the theft of stolen benefits prior to October 18, 2023, you have until November 18, 2023, to submit this form to the Department. If the discovery of stolen benefits occurred after October 18, 2023, return within 30 days of your request.