Department of Social ServicesVirginia VA TreasuryHomeSecretary of the Commonwealth - Notary Commissi 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your case name and case number at the top of the form. This information is crucial for identifying your application.
3. Fill in your worker's name, locality, and agency telephone number. Ensure these details are accurate to facilitate communication.
4. Indicate your household size and certification period. This helps determine eligibility for SNAP or TANF benefits.
5. In the 'Details on Changes' section, report any changes in your household composition, such as new members moving in or out. Provide their names, dates of birth, and relationships.
6. Update your address if it has changed, including all relevant details like city and ZIP code.
7. Report any changes in income or work hours that may affect your benefits. Be specific about amounts and sources.
8. Review all entries for accuracy before submitting the form to ensure compliance with reporting requirements.

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