LDSS-5166 - Rev. 9/20 - New York State SNAP Application/Recertification Form

Sep 19, 2026

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LDSS-5166 (Rev. 9/20) is a New York State Application/Recertification form for Supplemental Nutrition Assistance Program (SNAP) benefits. It explains alternative-format notice requests, eligibility determination steps during application and recertification, and conditions that may allow expedited processing. The form provides guidance on where to apply in and outside New York City, includes a federal non-discrimination notice, and requests applicant information such as identity, contact details, household-related status, and demographic questions.

LanguageEnglish

CategoryForms

FormatPDF

Pages8

Reading Time3 min

AccessFree to download

Application Information

Alternative Format Notices

When You Are Applying For SNAP

When You Are Recertifying For SNAP

Need SNAP Benefits Right Away? (Expedited Processing)

Where You Can Apply For SNAP

Non-Discrimination Notice

Applicant Details

LDSS-5166 (Rev. 9/20) NewYork State Office of Temporary and Disability Assistance Application/Recertification for Supplemental Nutrition Assistance Program (SNAP) Benefits If you are blind or seriously visually impaired, would you like to receive written notices in an alternative format? Yes No If yes, check the type of format you would like: Large Print Data CD Audio CD Braille, if you assert that none of the other alternative formats will be equally effective for you. If you require another accommodation, please contact your social services district. When You Are Applying For SNAP • You can file an application the same day you receive it. We must accept your application if, ata minimum, it contains your name, address, (if you have one), and a signature. This information will establish your application filing date. • You must complete the application process, including having an interviewand signing the certification statement on page 2 of the application/recertification foryour eligibility to be determined. If you are eligible, benefits will be provided back to the date you filed your application. • You can apply for and get SNAP for eligible household member(s) even if you or some other members of your household are not eligible for benefits because of immigration status. For example, ineligible alien parents can apply for SNAP for their children and receive benefits for their eligible children. • You can still apply and be eligible for SNAP even if you have reached your Temporary Assistance time limits. When You Are Recertifying For SNAP • You must submit the signed and completed recertification application. Remember to sign your application. LDSS-5166 (Rev. 9/20) NewYork State Office of Temporary and Disability Assistance Need SNAP Benefits Right Away? You May Be Eligible for Expedited Processing of your SNAP Application: If your household has little or no income or liquid resources, or if your rent and utility expenses are more than your income and liquid resources, or you are a migrant or seasonal farmworker with little or no income or resources when you apply, you may be eligible to get SNAP within 7 calendar days of the date you apply. When a resident of an institution is jointly applying for SSI and SNAP prior to leaving the institution, the recorded filing date of the application is the date of release of the applicant from the institution. Where You Can Apply For SNAP If you live outside of NewYork City, [you can apply online at myBenefits.ny.gov](you can apply online at myBenefits.ny.gov), or call or visit the social services district in the county where you live and ask for an application package, which can be mailed or dropped off at that appropriate office. You can getthe address and pohone number of the social services district in your county by calling toll free 1-800-342- 3009. If you live in New York City and are NOT also applying for Temporary Assistance, you can apply online at Access HRA, or call or visit any SNAP Office and ask for an application package. You can getthe address and phone number by calling 1- 718-557-1399 or toll free 1-800-342-3009. Non-Discrimination Notice – In accordance with Federal civil rights lawand U. S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, sex, religious creed, disability, age, political beliefs, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA. Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audio tape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disa

FAQs

Who should request alternative-format notices on the LDSS-5166 form?

If you are blind or seriously visually impaired and want written notices in an alternative format, you can indicate your preferred type such as large print, data CD, audio CD, or Braille.

What is required to complete the SNAP application or recertification process?

You must complete the process, including having an interview and signing the certification statement on page 2 for eligibility to be determined.

When can a household receive SNAP benefits quickly through expedited processing?

Expedited processing may apply when the household has little or no income or liquid resources, or when rent and utility expenses exceed income and liquid resources, including for migrant or seasonal farmworkers with limited resources.

Sep 19, 2026

Upload by Violet