470-2881 (Rev. 05/24) H2881 Page 1
Iowa Department of Health and Human Services
Review/Recertification
Eligibility Document
Case Number
County Number
Worker Name
Notice of Expiration - Please follow the instructions of the checked boxes below.
SNAP Notice of Expiration: Your SNAP will end . Return this signed form by
or you may not get SNAP at the regular time next month.
If this box is checked, you must have an interview for SNAP. A worker will contact you by phone or
appointment letter. You may request a face-to-face interview. If you miss the interview, your benefits may be
delayed or canceled. You must ask your worker to reschedule and also provide required verification.
FIP/Refugee Cash Assistance: It’s time to review your case. Please fill out this form and return it, along with any
proof, as listed below by . This information will be used to decide if you will continue
to get Family Investment Program (FIP) or Refugee Cash Assistance benefits.
You can turn in this document and the proof (listed on page 2) we need to make a decision on your benefits in
any of the following ways:
▪ Mail to the address above,
▪ Email to:
▪ Fax to: or
▪ Drop it off at any local HHS office.
▪ If you have questions, call your worker at
▪ You have the right to ask for an application and submit it with readable name, address, and signature, at any
time.
▪ You have the right to request a fair hearing if your recertification is denied or if you don’t agree with the
amount of benefits. See page 9 for more information.
▪ If your household’s only income is from Supplemental Security Income (SSI), you may apply for SNAP
recertification at any Social Security Administration office.
470-2881 (Rev. 05/24) H2881 Page 2
Documents We May Need
Don’t delay turning in this form to look for these items. If you don’t turn them in with your form, we
will mail you a letter telling you exactly what we need from you. When you apply for Supplemental
Nutrition Assistance Program (SNAP) benefits, you need to give us certain documents. Your documents help show
that what you reported on your application is correct. This page tells you what documents we need based on your
household situation. Items with an * are required for Family Investment Program (FIP) and Refugee Cash Assistance
(RCA) as well.
We will need information for you and anyone in your household applying for SNAP benefits. Your household is
anyone who lives with you and purchases and prepares food with you. Please only give copies of your documents.
We cannot return any original documents to you.
Identity – proof of who you are:
▪ Driver’s license or State identification card
▪ School or work ID
▪ Voter’s registration card
Residency – proof of where you live:
▪ Driver’s license or State identification card
▪ Utility bills (such as electric, gas, water, phone)
▪ Mail sent to you at the address on page 1
Social Security Number (SSN)*
▪ We need the SSNs, or proof that you applied for one, for all the people you are applying for.
Immigration status*
▪ Immigration and naturalization documents only if you aren’t a U.S. citizen
You may need to provide other documents depending on your situation.
If someone is working – proof of the money received in the last 30 days*:
▪ Paystubs
▪ Statement from the employer (if you are paid in cash or don’t have your paystubs)
▪ If self-employed, 12 months of business records
If someone has other income, not from working – proof of that money received in the last 30 days*:
▪ Social Security, SSDI
▪ Supplemental Security Income (SSI)
▪ Veterans Administration (VA)
▪ Child support
▪ Retirement or pension
▪ Unemployment benefits
If someone is responsible to pay any of the following expenses you may be able to get a deduction –
proof of the amount they were billed in the last 30 days:
▪ Rent or mortgage (including property taxes and homeowner’s insurance)
▪ Utilities (electric, gas, water, phone)
▪ Day care expenses for a child or disabled adult
▪ Medical bills for anyone who is disabled or over the age of 59
▪ Court-ordered child support*
If someone has any of the following assets/resources, tell us about them on page 5. You don’t have to
send proof now, we may ask for proof later*:
▪ Cash on hand
▪ Money in bank accounts and credit unions
▪ Stocks or bonds
▪ Motor vehicles such as cars, trucks, motorcycles, campers, and boats
▪ Land, buildings, or homes other than the home you live in
What you need to do now
▪ Fill out this form. Make sure you sign and date page 6. Use extra paper if you need to.
▪ Send proof if the question has the following by it: I
▪ Include your name and Case Number on any proof you submit.
SEND PROOF
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Have you moved? Give us your new address if you moved.
Street Address
City, State, and ZIP Code
Mailing Address (if different)
City, State, and ZIP Code
Household Members – These people get benefits with you or are counted to figure your benefits:
Name/State ID
Social Security
Number (SSN)
Age
Last Grade
Completed
in School
Citizen?
Yes/No
If Alien, Status?
Has anyone listed above moved in or out of your home or is there anyone else living in your home that is not listed
above? Yes No If yes, fill out the information below.
Name
Relationship
to You
Birth
Date
Last Grade
in School
*
SSN
Date
Moved
In/Out
Ethnicity
**
Race
***
Citizen
Yes/No
If Alien,
Status
Note: Last Grade in School* is only required for FIP.
We have to ask for ethnicity and race, but you don’t have to answer. The reason for the information is to ensure
that program benefits are distributed without regard to race, color, or national origin. Your answer won’t affect how
much you get or how soon. If you choose to answer, use the following codes:
**Ethnicity
***Race (Choose all that apply)
H = Hispanic or Latino
N = Not Hispanic or Latino
W = White
B = Black or African American
A = Asian
I = American Indian or Alaskan Native
N = Native Hawaiian or other Pacific Islander
Is anyone fleeing to avoid prosecution, custody, or jail for a felony crime?
Yes
No
Is anyone violating a condition of probation or parole?
Yes
No
Is anyone in or expecting to go to jail or prison?
Yes
No
Has anyone been disqualified from SNAP in any state for fraud or a program violation?
Yes
No
List anyone in your household who:
Dropped out or no longer attending school full-time _________________________________________
Is in a college or training program, include which school or program______________________________
Is in the military, a veteran, or a spouse of a veteran, include their status___________________________
Aged out of foster care ______________________________________________________________
Is experiencing homelessness___________________________________________________________
Is pregnant ________________________________________________________________________
List the most recent address of each parent not in the home. Only complete if you receive FIP.
Name of Parent
Not Living in the Home
Address of this Parent
Name of this Parent’s Children
470-2881 (Rev. 05/24) H2881 Page 4
Income – Send all pay stubs or proof of income for the last 30 days.
You must tell us about all money the people in your household get.
▪ If you leave a space blank: we will take that to mean no one in your household gets money of this kind. Please
use an additional sheet of paper, if needed.
▪ New jobs: send proof showing first pay date, hourly rate, and weekly number of hours.
▪ Job ended: send proof of the last pay date.
▪ Proof of tips: send pay stubs showing tips, employer’s statement, or your tip records.
List all jobs the people in your household have.
Who works?
Employer name?
Does this person get tips?
Yes No
Yes No
Will the amount of money from jobs stay about the same as shown on the proof you are
sending? If no, explain
Yes
No
Has anyone been hired for a job but not received a paycheck yet?
Yes
No
If yes, who? New employer name
Rate of pay Hours worked per week
Has anyone’s job ended in the last 30 days?
Yes
No
If yes, who? Employer name?
Will the amount of other money stay about the same as shown on the proof you are sending? Yes No
If no, explain
Expenses – Send proof of expenses for the last 30 days.
If you have day care expenses for a child or a disabled adult who lives with you, tell us how much you are
responsible to pay below. We need proof of how much you are responsible to pay to see if you can get a deduction.
Proof can be receipts or statement of expenses from the provider.
Who gets care: Amount you pay $ per month
If anyone pays court-ordered child support, tell us how much you pay below. We need proof of how much you pay
to see if you can get a deduction.
Who pays: Amount you pay $ per month
If you have medical expenses not paid by insurance for anyone who is disabled or over age 59, tell us. These could
be doctor or hospital bills, medicine, transportation, health insurance premiums, home health costs, health-related
supplies, medical equipment, or other medical expenses. Send proof if your expenses have changed.
Who pays: Amount you pay $ per month
What other money do people in your household get?
Who gets the money?
How much per month?
SEND PROOF
Self-Employment or Odd Jobs
(Send the most recent federal tax forms. If tax return was not filed,
send records that show income and expenses.)
Unemployment or Worker’s Compensation
Social Security or SSI
Veterans Benefits, Pensions or Retirement
Child Support or Alimony
Bonuses, Commissions, or Interest Income
Money from Friends or Relatives
Other: (Including irregular or one time payments)
Explain:
SEND PROOF
SEND PROOF
470-2881 (Rev. 05/24) H2881 Page 5
Shelter and Utilities – Send proof of expenses for the last 30 days.
Only answer these questions if you get SNAP.
Proof for renters can be a lease agreement or written statement from the landlord or housing
authority. Proof for homeowners can be mortgage, property tax, and insurance statements.
Do you get rent assistance? Yes No
If yes, enter the exact amount you are responsible to pay. Do not estimate. $ per month
Rent $_____________ per month
Lot rent $___________ per month
Mortgage $__________ per month
If you pay taxes or insurance separate from your mortgage, list the exact amounts below.
Do not estimate.
Property taxes: $ every 1 3 6 12 months
Homeowner’s insurance: $ every 1 3 6 12 months
Check the boxes if you pay any of the following.
Lights/Electricity
Water and Sewage
Garbage and Trash
Gas
Telephone
Extra charges from your landlord
Garage Rent
Pet Fees
Other, explain ____________________________________________________________________
Check the boxes if:
Any of the utility bills you have to pay are for heating or cooling/air conditioning.
You got energy assistance in the past year.
Your utilities are included in your rent.
Anyone helps you pay rent, utilities, or other expenses. Example: roommate, parent, friend, etc.
If yes, who helped and which expenses did they pay?
Resources (Assets)
Does anyone have a car, truck, boat, camper, motorcycle or other vehicle? Yes No
If yes, list make, model, year below.
List the money anyone has in:
Checking/savings or other
bank/credit union accounts $ Who?
Cash $ Who?
Stocks, bonds, savings certificates,
annuities, IRAs, Keogh or other assets $ Who?
List anyone who has or owns any land, buildings,
or houses, other than the house you live in:
List anyone who has a conservatorship or trust:
Does anyone have life or death benefit insurance? Yes No
For FIP, list any tools, machinery, livestock, or collections that anyone has:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
SEND PROOF
470-2881 (Rev. 05/24) H2881 Page 6
Help With Your SNAP – Authorized Representative
If you feel like you need help from someone else to be at your HHS interviews, complete your HHS documents,
answer HHS questions, and buy food for you with your EBT benefits, you can tell us who that is. The person who
represents you to HHS is called your Authorized Representative. It’s very important to pick an Authorized
Representative who you trust and can rely on. Any information given to HHS from your Authorized Representative
is the same as if that information came from you. If they give wrong information and you get too many benefits, you
will have to pay those benefits back. If they use your EBT benefits, you can’t get those benefits replaced. You don’t
have to have an Authorized Representative. It’s optional and is your decision.
I understand what having an Authorized Representative means and I would like to have one. I understand HHS will
be able to share my information with the person I list below.
Name: Telephone number:
Address:
Email address:________________________________________ Relationship to you: ____________________
Expected Changes – Tell us if anything has changed or is expected to change.
Sign and Date
I certify, under penalty of perjury, that:
▪ The answers I give are correct and complete to the best of my knowledge.
▪ My answers about citizenship or alien status of each person applying for assistance are correct.
I know what I reported may cause my benefits to be reduced, increased, or stopped and that the Department of
Health and Human Services may check my case.
Your Signature or Mark
Phone Number
Today’s Date
Signature of Person, if Any, Who Helped
Complete the Form
Phone Number
Today’s Date
Email Address
Do you need an interpreter? If so, which language?
I authorize HHS to communicate confidential information with me by email at the email address I provided above.
Confidential information includes anything needed for HHS to process my application. By giving HHS my email
address, I understand that it is my responsibility to tell my HHS worker if my email address changes or to stop
communicating with me by email.
If you want to register to vote, you can complete a voter registration form at
https://hhs.iowa.gov/sites/default/files/Voter_Registration.pdf. Applying to register or declining to register to vote will
not affect the amount of assistance that you will be provided by this agency.
470-2881 (Rev. 05/24) H2881 Page 7
Iowa Department of Health and Human Services
Optional Release of Information
Help Us Help You!
You do not have to sign this, but it will help us get information we need to help you,
without having to get your signature on specific requests.
You should know that:
▪ We may need more information to decide if you can get assistance.
▪ If more information is needed from you, you will get a letter telling you what we need and the date you must get
it to us.
▪ You are responsible to get the information or to ask us for help to get it.
▪ If you do not give us the information or ask for help by the due date, your application may be denied or your
assistance may stop.
▪ We may be able to use the release below to get the information we need. But you still have to provide
information we request or ask us for help.
▪ We may attach a copy of this release to a form that asks other people or organizations (like your employer) for
specific information needed about you or others in your household.
Print and sign your name below to give us permission to get needed information. Remember to also
sign page 4.
RELEASE OF INFORMATION
I hereby authorize any person or organization to give the Iowa Department of Health and
Human Services requested information about me or other members of my household.
A copy of this release is as valid as the original.
This release does not apply to protected health information.
This release is good for 12 months from the date signed.
___________________________ ____________________________
Your Name (please print clearly) Other Adult Name (please print clearly)
___________________________ ____________________________
Signature or Mark Signature or Mark
___________________________
Date
470-2881 (Rev. 05/24) H2881 Page 8
470-2881 (Rev. 05/24) H2881 Page 9
Please keep the following pages for your information.
Social Security Number (SSN) and Immigration Status Information
We can give help only to people who give us their SSN or proof of application from the Social Security office. You
don’t have to give us the SSN for people in your household who you do not want help for, but you can
choose to give us their SSN. However, we will use any SSN given to us the same way we use the SSN of people
getting assistance. If you do not give us an SSN for people in your household, we will deny assistance to those people.
There are some exceptions to this. Please ask your worker. We will not give any SSN to the Citizenship and
Immigration Service.
You can apply for part of your household even if some members do not have lawful immigrant status. For example,
parents who do not have lawful immigrant status may apply for their children who are U.S. citizens or qualified lawful
immigrants. You need to give proof of immigration status or U.S. citizenship for each person in your household for
whom you apply. Your household’s alien status may be checked with the Citizenship and Immigration Service
(USCIS). Any information we get from USCIS may affect your household’s benefits. We will not contact the
Citizenship and Immigration Service about the people you don’t apply for. However, we may use their income and
assets to see if the rest of the household can get help.
You Have the Right to Appeal An appeal is a request for a hearing regarding a decision made by the Department.
You can appeal in person, by telephone, or in writing for SNAP and FIP. To appeal in writing, you must do one of the
following:
• Complete an appeal electronically at https://hhs.iowa.gov/programs/appeals, or
• Write a letter telling us why you think a decision is wrong, or
• Fill out an Appeal and Request for Hearing form. You can get this form at your county HHS office.
Send your appeal to HHS, Appeals Section, 321 E. 12
th
St., Des Moines, IA 50319-1002. If you need help filing an
appeal, ask your county HHS office. You can represent yourself. Or, you can have a friend, relative, lawyer, or
someone else act on your behalf. You may contact your county HHS office about legal services. You may have to pay
for these legal services. If you do, your payment will be based on your income. You may also call Iowa Legal Aid at
(800) 532-1275. If you live in Polk County, call (515) 243-1193.
You Will Not Be Discriminated Against
It is the policy of the Iowa Department of Health and Human Services (HHS) to provide equal treatment in
employment and provision of services to applicants, employees and clients without regard to race, color, national
origin, sex, sexual orientation, gender identity, religion, age, disability, political belief or veteran status.
If you feel HHS has discriminated against or harassed you, please send a letter detailing your complaint to: HHS,
Bureau of Human Resources, 321 E. 12
th
In accordance with federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and
policies, this institution is prohibited from discriminating on the basis of race, color, national origin, sex (including
gender identity and sexual orientation), religious creed, disability, age, political beliefs, or reprisal or retaliation for
prior civil rights activity.
Program information may be made available in languages other than English. Persons with disabilities who require
alternative means of communication to obtain program information (e.g., Braille, large print, audiotape, American Sign
Language), should contact the agency (state or local) where they applied for benefits. Individuals who are deaf, hard
of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339.
To file a program discrimination complaint, a Complainant should complete a Form AD-3027, USDA Program
Discrimination Complaint Form which can be obtained online
at: https://www.usda.gov/sites/default/files/documents/ad-3027.pdf, from any USDA office, by calling (833) 620-1071,
or by writing a letter addressed to USDA. The letter must contain the complainant’s name, address, telephone
number, and a written description of the alleged discriminatory action in sufficient detail to inform the Assistant
Secretary for Civil Rights (ASCR) about the nature and date of an alleged civil rights violation. The completed AD-
3027 form or letter must be submitted to:
1. mail:
Food and Nutrition Service, USDA
1320 Braddock Place, Room 334
Alexandria, VA 22314; or
2. fax:
(833) 256-1665 or (202) 690-7442; or
3. email:
This institution is an equal opportunity provider.
Do Not Mail Applications to the Above Address
470-2881 (Rev. 05/24) H2881 Page 10
SNAP, FIP, and RCA
We Check What You Tell Us
The information you give us may be checked by federal, state, and local officials to make sure it is true. Things we
might check are any listed person’s: social security number, job and pay, bank account amount, amounts received
from other sources like Social Security or unemployment, and alien status. If any information you give us is not
correct, we may deny your application.
We may check records from other states to see if any person in your household can get benefits in Iowa. This may
be because a person was disqualified from a program in another state.
We check and use computer systems like the state Income and Eligibility Verification System. If something you told us
is different from what the computer system tells us, we will check to find out what is correct. We might check your
information by contacting your employer, your bank, or other people. Such information may affect your household’s
eligibility and level of benefits.
Things You Need to Know
• HHS may give your answers to law enforcement officials to catch persons fleeing to avoid the law.
• The Quality Control unit or Investigations unit may review your case. They may contact other people or
organizations to get proof of your information. By signing this application, you give permission to release
confidential information to the Quality Control unit or Investigations unit. You must cooperate with Quality
Control and Investigations to keep your FIP benefits. You must cooperate with Quality Control to keep your
SNAP benefits.
• We will use the information you give us to determine what assistance you are eligible to receive.
• You will have to pay back any benefits you got or that was paid to a third party on your behalf for which you
were not eligible.
• Section 1128B of the Social Security Act provides federal penalties for fraudulent acts and false reporting in
connection with these programs.
• Anyone who gets, tries to get, or helps any other person get assistance to which they are not entitled, is
guilty of violating the laws of the state of Iowa. This includes, but is not limited to, Iowa Code Chapters 239B,
243, 249, and 249A.
• Your expenses may be used to figure the amount of assistance you get. You may have expenses included in
your benefit calculation by reporting and giving proof of your expenses. If you do not report or give proof of
your expenses, you choose not to claim the expense. You can report and give proof later, and the expense
can be used for future months.
You also have the right to:
• Have someone help you complete the application.
• Have all of your questions answered.
• Get information about programs you applied for and any other HHS programs you may be able to get.
• Be sent a notice if you are eligible and when your benefits change or stop.
• Have information about you and your family kept private.
To report a change
• Call: 1-877-347-5678 Monday – Friday 7:00 a.m. to 6:00 p.m., excluding state holidays
• Email: [email protected]
SNAP Only - Follow these SNAP rules:
• Don’t hide or give wrong information on purpose to get SNAP benefits.
• Don’t use SNAP benefits to buy non-food items like alcohol or tobacco.
• Don’t trade, sell, or give away SNAP benefits.
• Don’t use someone else’s SNAP benefits for yourself.
• Don’t purchase a product with SNAP benefits that has a container requiring a return deposit with the intent
of obtaining cash by intentionally discarding the product and intentionally returning the container for the
deposit amount.
• Don’t buy food on credit and attempt to pay for it with SNAP.
• Don’t buy a product with SNAP benefits so you can get cash or something other than eligible food by
reselling that product.
• Don’t fail to report if your household goes over its income limit.
If you get SNAP, your worker will tell you what your household’s income limit is. If your household’s income
goes over your limit, or if anyone in your household receives lottery or gambling winnings of $3,500 or more
in any month, you must tell us by the 10th day of the next month. If you don’t tell us on time, you might have
to pay back the benefits.
470-2881 (Rev. 05/24) H2881 Page 11
Penalties of the SNAP Program. Anyone who breaks the above rules:
• May not get SNAP benefits for one year for the first time, two years for the second time, and
forever for the third time;
• May be fined up to $250,000 or jailed up to 20 years or both; and may also be subject to
prosecution under other applicable Federal and State laws.
• May be kept off SNAP for an additional 18 months, if court ordered.
• If a court finds you guilty of trading SNAP benefits for firearms, ammunition, or explosives, you
will lose benefits forever.
• If a court finds you guilty of buying, selling, or trading more than $500 in SNAP benefits, you
will lose benefits forever.
• If a court finds you guilty of trading SNAP benefits for controlled substances, you will lose
benefits for two years the first time and forever the second time.
• You will not get SNAP for 10 years if you are found guilty of getting or trying to get SNAP in
more than one household at a time. This penalty happens if you give wrong information about
who you are or where you live.
Giving wrong information on purpose may result in us taking legal action against you, either criminal or civil.
It might also mean we reduce your benefits or take money back from you.
Things You Need to Know
• Households eligible for SNAP may get a notice that they are eligible for the “Promoting Awareness of the
Benefits of a Healthy Marriage” program and a pamphlet listing those benefits. By giving this information, HHS
can use different rules that may help you get SNAP.
• If you have a SNAP overpayment, HHS will give your answers to federal and state agencies as well as private
claims collection agencies, to collect the overpayment.
• The SNAP office may contact other people or organizations to get proof of your information.
• The application filing date is different if your household is in an institution and applying for SNAP and
Supplemental Security Income at the same time. In this case, the filing date is the date of release from the
institution.
• You may not be denied SNAP benefits just because you were denied benefits from other programs. SNAP
applications will not be delayed due to requirements of other programs you may apply for.
• By having signed this application, you agree that all members of your household will register for work and
follow all of the work and training rules.
• To see what employment and training opportunities are available, you may contact:
o HHS SNAP Employment & Training (E&T) Program online at https://dhs.iowa.gov/food-
assistance/related-programs/employment-and-training or by phone at (515) 281-3131
o Your local IowaWorks Center. You may find your local work center at
https://www.iowaworkforcedevelopment.gov/contact
o United Way – 211
• The collection of information on the application, including the social security number of each household
member, is authorized under the Food and Nutrition Act of 2008 (formerly the Food Stamp Act of 1977), as
amended, 7 U.S.C. 2011-2036. The information will be used to determine whether your household is eligible
or continues to be eligible to participate in the SNAP program. We will verify this information through
computer matching programs. This information will also be used to monitor compliance with program
regulations and for program management.
• A household consisting of only Supplemental Security Income (SSI) applicants or recipients is entitled to apply
for SNAP recertification at a Social Security Administration office.
FIP or Refugee Cash Assistance (RCA) Only
Within 10 days of the date the change happens, you must tell HHS about changes, such as:
• Income, when it starts or stops, including getting an inheritance or a one-time payment of past due child
support
• Resources or assets
• Someone moving in or out of your home
• Mailing or living address
• Receipt of a SSN
• Change of school attendance of a child
If you receive FIP or Refugee Cash Assistance benefits, your SNAP may go down or stop.
Unless exempt, all members of your household must cooperate with the Family Investment Agreement (FIA) you
signed with PROMISE JOBS. Talk with your worker if you feel you have a reason not to cooperate. If you choose not
to participate in your FIA with PROMISE JOBS, your FIP benefits will stop.
You must cooperate with Child Support Services. While you get FIP, you give up your rights to child support for the
months you are on FIP. The state of Iowa will keep your child support to pay back the money you get from FIP.
470-2881 (Rev. 05/24) H2881 Page 12
Using Your FIP/RCA Electronic Access Card (EAC) or Your Debit Card to Access FIP/RCA Funds
from Your Personal Bank Account
You cannot access your cash benefits with your EAC or personal debit card at a:
• Liquor store or any place that mainly sells liquor,
• Casino or other gambling or gaming establishment, or
• Business which provides adult-oriented entertainment in which performers disrobe or perform in an
unclothed state (such as a strip club).
This includes these types of businesses located in Iowa, on tribal land, or in any other state. If HHS determines that
you have accessed your cash benefits with your EAC or personal debit card at one of the above places you:
• Will have committed fraud,
• Have to repay the amount of cash accessed at the location, as well as any access fees, and
• Your family will not get cash benefits for three months with the first misuse and six months for each
additional misuse.
By having signed this application, you agree that no member of your household will use the EAC or your personal
debit card to access FIP/RCA funds at prohibited locations.
Additional responsibilities:
You must:
• Apply for and accept any benefits that you may be able to get.
• Give us information and provide proof when we ask for it.
• Fill out review forms when you are asked to.
Penalty for Getting FIP in More Than One State
You will not get FIP for 10 years if you are found guilty of getting or trying to get FIP in more than one state at a
time. This penalty happens if you give wrong information about where you live.
