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ELECTRONIC BENEFITS TRANSFER (EBT) CARD ISSUANCE AUTHORIZATION NEVADA (State of Nevada, Department of Information Technology)

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BROWSE STATE OF NEVADA, DEPARTMENT OF INFORMATION TECHNOLOGY (NV) FORMS

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Page 1 of 2 2321-EGB (08/19)
NEVADA STATE DIVISION OF WELFARE AND SUPPORTIVE SERVICES (DWSS)
ELECTRONIC BENEFITS TRANSFER (EBT) CARD ISSUANCE AUTHORIZATION
I have received training on the use of my Electronic Benefits Transfer (EBT) card and Personal Identification
Number (PIN), and I understand:
I am responsible for safeguarding my EBT card and PIN.
If either my TANF cash or SNAP benefit account is accessed by me, an authorized representative, or any
other person in possession of my EBT card and PIN, the transaction is considered authorized and the benefits
will not be replaced.
I must report a lost or stolen EBT card immediately by calling the FIS ebtEDGE Customer Service Hotline
at 1-866-281-2443. Neither my TANF cash nor SNAP benefits will be replaced for the time period between
the loss/theft of my EBT card and PIN, and the time I report the loss/theft to the FIS ebtEDGE Customer
Service Hotline (1-866-281-2443).
There is no restriction on the number of times I may use my EBT card.
Adjustments could be made to my TANF cash or SNAP EBT account to correct system errors.
I understand the state will remove or expunge any benefits remaining in my EBT account past the intended
period of use, and those benefits will not be restored. Expunged benefits will be applied to any outstanding
agency debt.
Temporary Assistance to Needy Families (TANF)
Cash Benefits
Purpose
DWSS provides cash benefits to low-income residents
with a dependent child(ren).
These benefits help pay for basic living expenses.
TANF cash benefits must be used only for the benefit
of the children in your care.
We can require proof you are using your TANF
benefits for the children’s needs.
The intended period of use for TANF cash benefits is
180 days from issuance.
Appropriate Use
You may use your cash benefits for living expenses
such as:
• Shelter
• Fuel for heating
• Cooking and water heating
• Electricity for refrigeration and lights
• Household supplies
• Clothing
• Personal incidentals
I may make cash purchases using my TANF cash
benefits and receive cash back with no additional fee
depending on the store’s policy.
Automated Teller Machine (ATM) Fees
I may also withdraw cash from an ATM; however,
there is always an 85-cent fee each time I receive cash
from an ATM, and there is a possible additional
charge, which could vary depending on the ATM I
use.
The agency does not pay or reimburse for ATM
surcharge fees.
Supplemental Nutrition Assistance Program (SNAP)
Food Benefits
Purpose
DWSS administers food assistance benefits under the
Federal Supplemental Nutrition Assistance Program
(SNAP).
SNAP benefits are intended to supplement the family’s
monthly food resources.
The intended period of use for SNAP benefits is 365
days from issuance.
Appropriate Use
SNAP benefits may be used by yourself or family
members to buy food from an authorized retailer.
Retailers are authorized by the United States Department
of Agriculture (USDA) through the Food and Nutrition
Service (FNS).
You may use your benefits to buy:
• Breads and cereals
• Fruits and vegetables
• Cheese, milk and dairy products
• Raw meats, fish, poultry and eggs
• Most other packaged foods other than prepared hot
foods
• Seeds and plants that produce food
A retailer who accepts my EBT card for purchases using
my SNAP benefits may not impose a minimum dollar
amount for my SNAP EBT purchase, nor can a retailer
charge a fee for the use of SNAP benefits.
Page 2 of 2 2321-EGB (08/19)
Fraudulent/illegal EBT transactions involving my TANF cash or SNAP benefits, may result in my disqualification
from the programs, the loss of benefits, monetary fines and imprisonment.
Temporary Assistance to Needy Families (TANF)
Cash Benefits
Restricted Use
Per Federal Law, TANF cash EBT benefits cannot
be accessed from ATM machines or used to purchase
items in the following locations: casinos, gaming
establishments, liquor stores, or establishments which
provide adult entertainment.
Restricted Use Penalty
If you use your EBT card or cash from your EBT card
illegally or inappropriately, we may:
• Require proof you use the benefits for the children
in your care.
• Assign a protective payee to manage your cash
benefits.
• Terminate your cash benefits.
• Pursue legal action, including criminal prosecution.
Supplemental Nutrition Assistance Program (SNAP)
Food Benefits
Illegal Use
It is illegal to:
• Sell or attempt to sell, your EBT card.
• Use SNAP benefits for anything other than to buy
food for eligible household members.
• Resell any food items purchased with SNAP benefits.
• Sell any items prepared with food purchased with
SNAP benefits.
• Use SNAP benefits to buy non-food items such as
cigarettes, tobacco, beer, wine, liquor, household
supplies, soap, paper products, vitamins, medicine or
pet food.
• Exchange your benefits, the food purchased with your
EBT card, for anything of value (trafficking).
Examples of illegal trafficking include exchanging
food benefits for cash, drugs or weapons.
Credit for the return of any items purchased with my
SNAP benefits must be placed on my EBT card; it is
illegal to accept cash or a “store” card for any returns
purchased with SNAP benefits.
Penalty for Illegal Use
If you intentionally misuse your SNAP benefits, you may
be:
• Disqualified and lose your benefits:
▪ For at least one year
▪ Up to 10 years
▪ For a lifetime
▪ Disqualified even if you move to another state
• Required to repay any trafficked benefits.
• Subject to fines.
• Subject to legal action, including criminal prosecution.
DWSS will cooperate with local, state and federal
authorities to prosecute trafficking of SNAP benefits.
By signing below, I agree that the appropriate and legal use of DWSS TANF cash and SNAP benefits have been
explained. I understand the proper use of benefits and the penalties for restricted and illegal use. SNAP benefits may
only be used by a Household member or authorized representative.
__________________________________________________ ________________________
Signature of Head of Household or Authorized Representative Date
Training Verification (for office use only)
Date of Training/Review of Training Documents: __________________ Trainer’s Initials: _______________
Card Issuance Authorization (for office use only)
Head of Household Name:
Authorized Representative
___________________________
Social Security #____________________
Case Manager/EBT
Initials
_______
Take this form to the Card Issuance Staff to receive your EBT card and select your PIN number.
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ELECTRONIC BENEFITS TRANSFER (EBT) CARD ISSUANCE AUTHORIZATION NEVADA (State of Nevada, Department of Information Technology)

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Completed 5 August 2021

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