T&L Properties Recertification Questionnaire

Number of Adult
Household Members *

Please complete the attached application in its entirety.

The following should be attached if applicable:
- Current Social Security or SSI* benefit award letter
- Current FIP letter*
- Current Unemployment benefit award letter*
- Case numbers and, if applicable, pin numbers, for all court-ordered child support
- Online or ATM printout for all pre-paid debit cards in your possession
* Please note that these items must be dated within 90-days of your recertification effective date.

Save & Return Account (optional)
New Users / Returning Users CLICK HERE to setup or return to your account for this form. Creating an account enables you to return to this form and your submitted results. An account will also enable you to partially complete this form and return later to finish. The account you establish is only for this form.

This institution is an equal opportunity provider and employer.

If you wish to file a Civil Rights program complaint of discrimination, please complete the USDA Program Discrimination Complaint form, found online at http://www.ascr.usda.gov/complaint_filing_cust.html, or at any USDA office, or call (866) 632-9992 to request the form.  You may also write a letter containing all of the information requested in the form.  Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, by fax (202) 690-7442 or email at program.intake@usda.gov.