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It collects household composition and rent/utility details needed to determine TANF, Medicaid, and SNAP eligibility, including client identification, resident names, move-in dates, forwarding address, and questions about government-provided housing or rent portions under HUD programs. The form also requests monthly rent or market value, payment status, payment method, utility reimbursement amounts, heating/cooling and appliance or furniture rental fees, and whether outside parties pay rent. Signature and contact fields support confidentiality and accountability.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/2488-eg-housingrent-authorization-form-tanfmedicaidsnap-nevada/306155/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/2488-eg-housingrent-authorization-form-tanfmedicaidsnap-nevada/306155.png","ImageObject",442,249,{"name":88,"@type":89},"Ivy","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-09","2026-09-19",true,{"@type":98,"interactionType":99,"userInteractionCount":73},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What information must be completed to avoid TANF and SNAP ineligibility?","Question",{"text":108,"@type":109},"The form states the needed information must be in the office on or before the specified deadline. It warns that failure to provide the information may cause TANF and SNAP ineligibility.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"Who is allowed to complete the form?",{"text":113,"@type":109},"The form indicates it is to be completed by a landlord or manager only, or in the case of a limitation, by a friend or neighbor as allowed by the form wording.",{"name":115,"@type":106,"acceptedAnswer":116},"What rent-related items are requested on the form?",{"text":117,"@type":109},"It requests total monthly rent or estimated market value, whether government entities provide housing or pay a portion of the rent, rent payment status and date, payment method, utility reimbursement payment and start date, and whether heating/cooling and appliance or furniture rental fees are included.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},306155,1791585804,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":135,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":73,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":9},549758252649,"https://ap-avatar.wpscdn.com/avatar/8000253669c5317157?_k=1778319167496531819","Joe Lombardo Governor  \nLaura Rich Director  \nDEPARTMENT OF HUMAN SERVICES  \nDIVISION OF SOCIAL SERVICES Helping people. It’s who we are and what we do.  \nRobert H.Thompson Administrator  \nTANF MEDICAID SNAP  \nDate:    \nCase Name:    \nCase ID:    \n\n| AUTHORIZATION: I authorize you to release to\u003Cbr>the Division of Social Services information.\u003Cbr>the requested |\n| --- |\n| Client Signature Date |\n\nRENT/HOUSEHOLD COMPOSITION  \nThe following information is necessary to complete you case and must be IN our office on or before undefined . FAILURE TO PROVIDE THIS INFORMATION MAY CAUSE TANFAND SNAP INELIGIBILITY.  \nTO BE COMPLETED BY: Landlord or manager only Friend or neighbor  \nUNDER NO CIRCUMSTANCES CAN ANYONE LIVING IN THE HOME OR A RELATIVE COMPLETE THIS FORM.  \nPlease provide the information below and return to the above address. Your cooperation will help ensure integrity and maintain accountability in the administration of public funds in Nevada. The information provided us will be used only in conjunction with the official duties of this department and will be considered confidential. An immediate response would be appreciated.  \nIf our identifying information (name and address) does not agree with your records please indicate the change.  \nRE:      \n(Name) (Street/Residence Address)  \n1. List the full names of EVERY person (INCLUDING the above person) living at the above address:  \n2. When did   begin living at this address?    \n3. If no longer living at this address, date moved    \nForwarding address    \nStreet City State Zip  \n2488-EG (278 .0.0) Page 1 of 2  \n4. DOES A GOVERNMENTAL ENTITY PROVIDE HOUSING OR PAY A PORTION OF THE ABOVE CLIENT'S RENT?  \nYES NO IF YES, WHO?    \nRedetermination/Review Date    \nUnder what program? HUD Conventional Public Housing Section 8  \nHUD Indian Housing: Mutual Help OR Rental Assistance FmHA Rental Assistance Other  \n5. Total monthly rent or estimated market value of rent $  ,  pays $   \nClient's Name  \nAmount of utility reimbursement payment  $  Date payment started    \n6. Is the rent paid to date? YES NO Date paid   First Month's Rent  $   \n7. How is the rent paid (cash, personal check, money order, paycheck, etc.)?    \n8. List all responsible parties to the terms of the lease.  \n9. Does a person outside the household pay any portion of the rent? YES NO  \nIf YES, specify who:   Amount  $   \n10. Does rent include heating and cooling? YES NO Amount  $   \nAppliances/furniture rental fee? YES NO Amount  $   \n11. Does anyone in the household work in exchange for rent? YES NO  \nIf YES, who:   Date started   Amount  $   \n12. Please verify the amount of utility allowance the client receives monthly  $   \nDate payment started   Is amount paid to client? YES NO  \nSignature Print Name Title/Relationship Date Telephone Number  \nAddress   Agency Name   Apartment Complex    \n2488-EG (278 .0.0) Page 2 of 2","cbCaikszTrQQsVVx","https://ap.wps.com/l/cbCaikszTrQQsVVx","pdf",470757,8,"English","# Authorization and Signatures\n## Client Signature and Authorization to Release Information\n# Rent/Household Composition Details\n## Household Members and Move Dates\n## Government Housing Programs and Review Dates\n## Rent Payment Terms, Utilities, and Fees","[{\"question\":\"What information must be completed to avoid TANF and SNAP ineligibility?\",\"answer\":\"The form states the needed information must be in the office on or before the specified deadline. It warns that failure to provide the information may cause TANF and SNAP ineligibility.\"},{\"question\":\"Who is allowed to complete the form?\",\"answer\":\"The form indicates it is to be completed by a landlord or manager only, or in the case of a limitation, by a friend or neighbor as allowed by the form wording.\"},{\"question\":\"What rent-related items are requested on the form?\",\"answer\":\"It requests total monthly rent or estimated market value, whether government entities provide housing or pay a portion of the rent, rent payment status and date, payment method, utility reimbursement payment and start date, and whether heating/cooling and appliance or furniture rental fees are included.\"}]","2488-EG - Housing/Rent Authorization Form (TANF/Medicaid/SNAP) - Nevada | PDF",1789833283]