Income Maintenance Administration Application for Benefits   With the Combined Application for Benefits, you can apply or be recertified for one or more of the following assistance programs: Financial Assistance/TANF, Supplemental Nutrition Assistance Program/SNAP (formerly known as Food Stamps) and/or Medical Assistance. Download the Combined Application for Benefits* (English) Download the Combined Application for Benefits* (Spanish) Online Preliminary Interview for Benefits If you are currently receiving benefits and are applying for RECERTIFICATION of Food Stamps or Financial Assistance/TANF this application form will be used for recertification of benefits. A different form will be provided if you are requesting recertification for Medical Assistance only. This application contains information about the programs available at your local service center office, plus other very important information you should know, including your rights and responsibilities. READ THIS APPLICATION CAREFULLY AND THOROUGHLY. Complete and Accurate Information You must give complete, accurate, and truthful information. If you refuse to give needed information, your eligibility for assistance may be denied. If you knowingly give false, incorrect or incomplete information, or fail to report changes, you could lose your benefits and be prosecuted, fined and/or imprisoned. If you knowingly give false, incorrect, or incomplete information in order to help someone else receive benefits, you could be prosecuted for fraud. Verification of Information The information that you give may be matched against federal, state, and local records including the Department of Employment Services and the Department of Motor Vehicles, and the Income and Eligibility Verification System (IEVS) to determine if it is correct, accurate, and truthful. As a condition of eligibility you must apply for and cooperate with the agency in obtaining a social security number for yourself and the persons for whom you are applying for assistance. In addition, your social security number will be used to verify your identity, prevent receipt of duplicated benefits, and make required program changes. This system uses your social security number to verify wages and salary, unemployment benefits, and unearned income by using records from the Internal Revenue Service and the Social Security Administration. Any difference between the information you give and these records will be investigated and may require a home visit. Information from these records may affect your eligibility and benefit amount.