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Louisiana CAFÉ Application Summary
Louisiana CAFÉ Application Summary Page 1 www.dcfs.louisiana.gov
**Keep in mind that you do not need to mail this print-out to your local agency.** Thank you for using Louisiana CAFÉ to apply for benefits/services. Stephanie Sykes, your application has been submitted on March 8, 2023 at 09:50 A.M. Your application date is March 08, 2023
Your application number is 920-***-****.
In your application, you have asked for these benefits/services:
• Supplemental Nutrition Assistance Program (SNAP) Applicant Information
Applicant Name User ID SSN
Stephanie D Sykes ad1e7j@r.postjobfree.com 9347 Date of Birth Apply for Voter Registration
05/27/1984 No
Where You Live Mailing Address
386 Brownville Rd
Natchitoches LA 71457
Home Phone Cell Phone Work or Other Phone
Voter Registration
Louisiana CAFÉ Application Summary
Louisiana CAFÉ Application Summary Page 2 www.dcfs.louisiana.gov If you are not registered to vote where you live now, would you like to apply to register to vote here today? (Check one)
IF YOU DO NOT CHECK EITHER BOX, YOU WILL BE CONSIDERED TO HAVE DECIDED NOT TO REGISTER TO VOTE AT THIS TIME. Applying to register or declining to register to vote will not affect the amount of assistance that you will be provided by this agency. Voter eligibility requirements are found on the voter registration application form.
Note: If you do register to vote, the location where your application was submitted will remain confidential. If you decline to register to vote, this fact will remain confidential. Applying to register or declining to register to vote will be used only for voter registration purposes. I do not want to register to vote.
If you would like help in filling out the voter registration application form, we will help you. The decision whether to seek or accept help is yours. You may fill out the application form in private. (Check One) For assistance in completing the voter registration application form outside our office, contact the Department of Children and Family Services at 1-888-LAHELPU or 1-888-***-****.
If completed outside our office, this declaration form and your completed voter registration application form (if you filled one out) should be returned to the DCFS ES Document Processing Center at P.O. Box 260031, Baton Rouge, LA 70826-9918.
No, I do not want help.
COMPLAINTS
If you believe that someone has interfered with your right to register or to decline to register to vote, your right to privacy in deciding whether to register or in applying to register to vote, or your right to choose your own political party or other political preference, you may file a complaint with the Louisiana Secretary of State, Commissioner of Elections, P.O. Box 94125, Baton Rouge, LA 70804-9125 or by calling 225-***-**** or 1-800-***-****.
Household Member Information
Name Relationship to Applicant SSN Date of Birth
Stephanie
38
Self 9347 05/27/1984
Household Summary
Household's Total
Earned Income Amount
Household's Total Unearned
Income Amount
Household's Total
Resources
Household's Total
Expenses
$0.00 $0.00 $0.00 $0.00
Types of Proof
Louisiana CAFÉ Application Summary
Louisiana CAFÉ Application Summary Page 3 www.dcfs.louisiana.gov As a next step, your worker may ask for proof of some of the things you told us in your renewal. This checklist will help you gather these items. If you can't find something, your worker may be able to help you get the proof you need. Keep in mind that this list is based only on what you told us today. There may be other items that your worker will ask you to provide.
Proof of Identity: Driver's license, work or school ID, ID for health benefits or another social services program, voter's registration card, check stub, or birth certificate Wages: Last 4 pay check stubs or employer's statement for each person who works Self-Employment: Income tax returns, sales records, quarterly tax records, personal wage record Other income such as contributions, child support, alimony, Social Security, SSI, VA, retirement checks, Unemployment Compensation (UCB): Award letters, court orders, statements from contributors Income that stopped within the last 3 months: Pink slip, termination notice, or statement from former employer, termination notice or statement from source of any income that ended Child support payments made to someone outside your home: Court order or other legal papers and proof that you are making payments such as cancelled checks or wage withholding statements
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