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PUB 1313 - Instructions for Completing the Recertification ...

PUB-1313 Statewide ( ) Instructions FOR Completing THE NEW YORK STATE Recertification form FOR: PUBLIC ASSISTANCE SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM MEDICAID AND SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM MEDICAID AND PUBLIC ASSISTANCE PUB-1313 Statewide (Rev7/20) PAGE 1 If you are blind or seriously visually impaired and need an application/ Recertification form or these Instructions in an alternative format, you may request them from your social services district (SSD). The following alternative formats are available: Large print Data format (a screen reader-accessible electronic file) Audio format (an audio transcription of the Instructions or application/ Recertification questions) Braille, if you assert that none of the alternative formats above will be equally effective for you Applications/ Recertification forms and Instructions are also available for download in large print, data format and audio format from or Please note that applications/ Recertification forms are available in audio format and Braille solely for informational purposes.

If you require another accommodation or need other help completing this recertification form, please contact your SSD. PAGE 1 OF THE RECERTIFICATION FORM SECTION 1: CHECK EACHPROGRAM YOU OR ANY HOUSEHOLD MEMBER ARE RECERTIFYING FOR . Check ( ) the box for each program that you or any household member wants to recertify for.

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