PURPOSE: To be used by the county to request a history of food stamp participation (the IM-116 report, Food Stamp Household Report). Generally it is used when preparing a claim.
NUMBER OF COPIES AND DISPOSITION: The county prepares one copy for the Income Maintenance FAMIS Unit and retains one copy for the case file. The copy may be destroyed upon receipt of the report (IM-116).
MANUAL REFERENCE: Food Stamp Manual 1100.000.00 - 1150.015.05 Chapter IX, Section VII
INSTRUCTIONS FOR COMPLETION This blank form is a shared document that can be retrieved from the online IM Forms.
DATE: Enter the date the IM-115 is completed.
COUNTY NUMBER: Enter the county number.
HEAD OF HOUSEHOLD: Enter the name of the head of household.
DCN (Departmental Client Number): Enter the DCN for the head of household.
SENDING AND FILING THE REQUEST
After the document is typed and saved, send the form electronically to Cole CoIDM by attaching it as an insert to an e-mail request. Print and file a copy of the request in the case record or establish some other control until you receive a response on IM-116.
Upon receipt of the IM-116, file it in the case record and take necessary action.