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Click ‘Get Form’ to open the h1855 form in the editor.
Begin by entering your Case No. and Certifying Office at the top of the form. This information is crucial for processing your request.
Fill in your Current Address, including City, State, and ZIP Code. Ensure that this information is accurate to avoid any delays.
Indicate the month for which you have not received SNAP benefits by filling in MM/YYYY under 'Priority benefits issued while TIERS was down'.
If applicable, provide your Old Address and details regarding Replacement Benefits, including Benefit Date (MM/YYYY), Allotment Amount, Original Issuance No., and Original Issue Date.
In case of a household disaster, specify the date when food was destroyed (MM/DD/YYYY) and the amount destroyed.
Finally, ensure you sign and date the affidavit at the bottom of the form. Remember that it must be submitted within 10 days of reporting.
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Form h1855 printableForm H1855, Affidavit for Nonreceipt or Destroyed SNAP benefitsH1855 online formSNAP replacement due to power outage 2026Form h1854SNAP benefits replacement formSNAP replacement due to power outage 2025Snap loss of food form
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This form is used to obtain a written statement from an applicant or client that the household has not previously received benefits that month, or had some
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