Instructions for Claiming Heating/Cooling Expenses or Receipt of Fuel Assistance

and Obtaining Past Food Stamp Benefits

If you have been paying for heating or cooling costs or receiving fuel assistance and the Department of Transitional Assistance (DTA) has not considered these expenses when calculating your food stamp amount, then you are entitled to have your food stamps recalculated and request a restoration of lost food stamp benefits. A restoration of lost benefits is the difference between what you should have received in food stamps and what you did receive for the months in which your household was eligible to participate. Benefits can be restored up to 12 months before the month that you notify your caseworker verbally or in writing that you might not have received all of the food stamps that you should have received.

Attached documents include a declaration form and cover letter that you can fill out (according to the instructions) and submit to the DTA.

If you need free legal assistance, contact your local legal service program.

EXAMPLE: Maria has been paying air-conditioning expenses since July 2003. She started receiving food stamps in September 2004, but DTA did not include her air-conditioning expenses when calculating her food stamp amount. Maria did not realize until March 2006 that her food stamps were not calculated based on the fact that she pays for air-conditioning. On March 30, 2006, Maria notifies DTA that her food stamps are too low and requests that her case be fixed for the future and that her “lost” benefits be restored. Maria can use the following declaration and cover letter forms to help her make these requests. However, Maria can only get lost benefits back to March 2005 (12 months before the month she notifies her caseworker), even though she was paying for air-conditioning expenses before that date.


Instructions for Declaration

TITLE: Insert your full name in the blank.

1.  Insert your full name in the blank.

2.  Insert the way you pay for your heating or cooling or whether you receive fuel assistance. (For example, “I run an air-conditioner and pay for cooling costs through electricity” or “I receive fuel assistance.”) Insert the month and year you started paying for heating/cooling/fuel assistance.

3.  Insert the month and year that is 12 months earlier than the current date, or the date that you first incurred heating/cooling/fuel assistance expenses, whichever is later.

SIGNATURE: Sign and date the declaration form. Print your full name and your Social Security Number.

Instructions for Cover Letter

(a)  Insert your full name, contact address, and phone number.

(b)  Insert date.

(c)  Insert your full name.

(d)  Insert your Social Security Number.

(e)  Insert the way you pay for your heating or cooling. (For example, “I run an air-conditioner and pay for cooling costs through electricity” or “I receive fuel assistance.”)

(f)  Insert the month and year you started paying for heating/cooling/fuel assistance.

(g)  Insert the month and year that you were receiving food stamps AND paying for heating, cooling, or fuel assistance.

(h)  Insert the month and year that is 12 months earlier than the current date, or the date that you first incurred heating/cooling/fuel assistance expenses, whichever is later.

(i)  Insert phone number.

(j)  Sign and print your full name.


Declaration of ______

  1. I, ______, would like my food stamp benefits amount reviewed and recalculated because my current benefit amount does not reflect my correct shelter expenses.
  1. I pay for heating/cooling expenses because ______. I have paid for heating/cooling expenses or received fuel assistance since ______, ______.
  1. I am also seeking a restoration of lost food stamp benefits to at least ______, ______.

X______

Signature Date

______

Printed Name Social Security Number


(a)______

______

______

______

(b)______

Assistant Director, Food Stamps

Department of Transitional Assistance Office

RE: Request for Restoration of Lost Food Stamp Benefits with (c)______, SSN (d)_____-____-______

Dear Assistant Director:

I am writing to ask for a recalculation of my current food stamps and a restoration of lost food stamp benefits, pursuant to 106 CMR 366.510.

The Department of Transitional Assistanceis not using the heating/cooling standard utility allowance when calculating my food stamp allotment, even though I have been

(e)______since (f)______, ______. Pursuant to 106 CMR 364.400(G)(2)(a), the heating/cooling standard utility allowance applies to households that incur heating or cooling costs separate from its rent or mortgage or receive fuel assistance. As a result, I have been underpaid food stamps since (g)______, ______. I am now asking that my food stamp case be corrected from now on. I am also asking to be provided with a restoration of lost food stamp benefits retroactive to at least (h)______, ______.

Please let me know about the amount of my corrected food stamp allotment and the amount of the restoration of lost benefits.

Please contact me if you have any questions. I can be reached at (i)(______)______-______. Thank you for your attention.

Sincerely,

(j)______

Form prepared by Massachusetts Law Reform Institute (05/06)