Gateway renew my benefits

Please note that Georgia Gateway will be unavailable during these times for planned system maintenance: 08:00 pm on Friday, 03/01/2024 to 8:00 pm on Sunday, 03/03/2024. ... Obtain benefit and office hours information at the websites below. Department of Family & Children Services (DFCS) at https://dfcs.georgia.gov/services. Women, Infants, and ...

Gateway renew my benefits. Georgia Gateway - Homepage Screen. Please note that Georgia Gateway will be unavailable during these times for planned system maintenance. 08:00 pm on Thursday, 05/02/2024 to 11:00 pm on Thursday, 05/02/2024. 06:00 pm on Saturday, 05/04/2024 to 11:00 pm on Saturday, 05/04/2024. Obtain benefit and office hours information at the …

Step 2 – Login GA Gateway Account. Step 3 – Access your Applications. Step 4 – Select Benefits to Renew. Step 5 – Provide your Household Information. Step 6 – Submit your Renewal Application.

Log in to your account to apply for, renew, and view your benefits. Use Georgia Gateway to apply online for benefits. Georgia Gateway is the state government’s web portal for accessing assistance programs. When you create an account, you can apply for or renew benefits, upload documents, and report changes to your case.Georgia Gateway - Homepage Screen. Please note that Georgia Gateway will be unavailable during these times for planned system maintenance. 08:00 pm on Thursday, 05/02/2024 to 11:00 pm on Thursday, 05/02/2024. 06:00 pm on Saturday, 05/04/2024 to 11:00 pm on Saturday, 05/04/2024. Obtain benefit and office hours information at the …Call a Department for Community Based Services (DCBS) Representative. A DCBS representative can: give you more information on state benefits. answer questions about your application. help you schedule an interview. tel:1 (855) 306-8959. 1 (855) 306-8959. Visit a DCBS Office. Visit a DCBS office to:Georgia Gateway is the central, easy way to apply for and get help with assistance in Georgia ... and you would like to create an account so you can manage your benefits online, select the Create an Account button below. Create an Account. If you would like to create or access your account to: Renew Benefits; Check Benefits; Upload a …Georgia Gateway is the central, easy way to apply for and get help with assistance in Georgia ... during these times for planned system maintenance. 08:00 pm on Friday, 04/26/2024 to 11:00 pm on Friday, 04/26/2024; Obtain benefit and office hours information at the websites below. ... is an automatic process to enroll or renew eligible children ...Georgia Gateway is the central, easy way to apply for and get help with assistance in Georgia ... and you would like to create an account so you can manage your benefits online, select the Create an Account button below. Create an Account. If you would like to create or access your account to: Renew Benefits; Check Benefits; Upload a …The time SNAP benefits last varies, but usually lasts anywhere from one to six months before benefits need to be renewed. When the person applies for benefits and receives an accep...

Georgia Gateway is the state’s integrated system for determining eligibility across multiple benefits programs. These programs include Medical Assistance (Medicaid, PeachCare …Please note that Georgia Gateway will be unavailable during these times for planned system maintenance: 08:00 pm on Friday, 03/01/2024 to 8:00 pm on Sunday, 03/03/2024. ... Obtain benefit and office hours information at the websites below. Department of Family & Children Services (DFCS) at https://dfcs.georgia.gov/services. Women, Infants, and ...GA Gateway Customer Server Phone Number. For more help with your Georgia Gateway online account otherwise for assistance renewing insert food stamps, please call the GA Gateway Patron Service phone number below: Georgia Gateway Customer Service Phone Number (Toll-Free): 1-877-423-4746.MyACCESS is a portal where Floridians can get and manage benefits online. This includes food assistance (SNAP) formerly food stamps, cash aid (TCA), and affordable health coverage (Medicaid)The renewal application must be completed and submitted to the state before the coverage period ends. Georgia residents can also renew their Medicaid coverage online using the Georgia Gateway portal. The Georgia Gateway is a website that allows residents to apply for, renew, and manage their public assistance benefits online.Getting your SNAP benefits quickly. If you have little or no income, you may qualify to get benefits within 7 days, also called expedited benefits. To find out if you qualify, visit the DFCS FAQ web page or call DFCS at 877-423-4746. If you are deaf or hard of hearing, please call GA Relay at 800-255-0135. These services are free.Please note that Georgia Gateway will be unavailable during these times for planned system maintenance: 08:00 pm on Thursday, 03/21/2024 to 11:00 pm on Thursday, 03/21/2024. ... If you would like to create or access your account to: Renew Benefits; Check Benefits; Upload a Document; Report a Change; View Notices; Select the …

Georgia Gateway - Homepage Screen. Please note that Georgia Gateway will be unavailable during these times for planned system maintenance. 08:00 pm on Thursday, 05/02/2024 to 11:00 pm on Thursday, 05/02/2024. 06:00 pm on Saturday, 05/04/2024 to 11:00 pm on Saturday, 05/04/2024. Obtain benefit and office hours information at the websites below. Renew by mail. Download and print the Medicaidrenewal form . Mail the completed form to your local DFCS office. You will receive a notice when your renewal has been completed by DFCS, your case will remain open until then. Renew by phone. You can speak with someone about your renewal by calling 877-423-4746 (TTY: 1-800-255-0556 or 711) within ...Log in to your account to apply for, renew, and view your benefits. Use Georgia Gateway to apply online for benefits. Georgia Gateway is the state government’s web portal for …Renew an electronic benefits transfer card or Supplemental Nutrition Assistance Program, or SNAP, account online by visiting the Food and Nutrition Services page of USDA.gov to acc...The Georgia Food Stamp Program (Supplemental Nutrition Assistance Program (SNAP), is a federally-funded program that provides monthly benefits to low-income households to …

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We would like to show you a description here but the site won’t allow us.Express Lane Eligibility (ELE) is an automatic process to enroll or renew eligible children under the age of 19 who are receiving Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF), Refugee Cash Assistance (RCA), Child Care and Parent Services (CAPS) or Women, Infants and Children (WIC) into the ...For example, if your benefits are scheduled to end in August, you should receive a Renewal letter from DFCS by July 20. If you do not receive your notification when expected or have any questions about renewing your SNAP benefits, call DFCS at 877-423-4746. If you are deaf or hard of hearing, please call Georgia Relay at 800-255-0135.Georgia Gateway - Homepage Screen. Please note that Georgia Gateway will be unavailable during these times for planned system maintenance. 08:00 pm on Thursday, 05/02/2024 to 11:00 pm on Thursday, 05/02/2024. 06:00 pm on Saturday, 05/04/2024 to 11:00 pm on Saturday, 05/04/2024. Obtain benefit and office hours information at the websites below.Georgia Gateway - Homepage Screen. Please note that Georgia Gateway will be unavailable during these times for planned system maintenance. 08:00 pm on Thursday, 05/02/2024 to 11:00 pm on Thursday, 05/02/2024. 06:00 pm on Saturday, 05/04/2024 to 11:00 pm on Saturday, 05/04/2024. Obtain benefit and office hours information at the websites below.Georgia Gateway is an online program where people can see their government aid status. ... "Everyone who has returned their renewal packet will receive benefits for prior months between August ...

499 followers. Mar 1, 2021 - Get step-by-step instructions on how to use www.gateway.ga.gov to renew my benefits and continue receiving Georgia food stamps. Georgia Gateway - Homepage Screen. Please note that Georgia Gateway will be unavailable during these times for planned system maintenance. 08:00 pm on Thursday, 05/02/2024 to 11:00 pm on Thursday, 05/02/2024. 06:00 pm on Saturday, 05/04/2024 to 11:00 pm on Saturday, 05/04/2024. Obtain benefit and office hours information at the websites below.The Supplemental Nutrition Assistance Program (SNAP), formerly referred to as the Food Stamp Program, is a federally funded program that helps low-income families pay for the cost of food. The SNAP program also provides opportunities to improve their economic standing with job skills training and other support.Use the ABE Manage My Case portal to manage your Medical, SNAP and Cash benefits - online, anytime. Find out more about linking your existing case to ABE Manage My Case (pdf) and review the ABE Customer Guide (pdf) by visiting the ABE Customer Support Center. By Phone. Call the DHS Help Line at 1-800-843-6154; 1-866-324-5553 TTYGeorgia Gateway is the central, easy way to apply for and get help with assistance in Georgia ... and you would like to create an account so you can manage your benefits online, select the Create an Account button below. Create an Account. If you would like to create or access your account to: Renew Benefits; Check Benefits; Upload a …Georgia Gateway - Homepage Screen. Please note that Georgia Gateway will be unavailable during these times for planned system maintenance. 08:00 pm on Thursday, 05/02/2024 to 11:00 pm on Thursday, 05/02/2024. 06:00 pm on Saturday, 05/04/2024 to 11:00 pm on Saturday, 05/04/2024. Obtain benefit and office hours information at the websites below.Georgia Gateway - Homepage Screen. Please note that Georgia Gateway will be unavailable during these times for planned system maintenance. 08:00 pm on Thursday, 05/02/2024 to 11:00 pm on Thursday, 05/02/2024. 06:00 pm on Saturday, 05/04/2024 to 11:00 pm on Saturday, 05/04/2024. Obtain benefit and office hours information at the websites below.If you work in the food service industry, then you understand the importance of food safety and hygiene. One crucial aspect of maintaining these standards is having a valid food ha...You can apply for benefits as well as check and manage your status through Georgia Gateway. Visit the Georgia Gateway website. Create an account or log in with your …Please enter User ID and Password to log into your Gateway account. If you need to create a new account, select the 'Create New Account' hyperlink. <link rel="stylesheet" href="styles.dbf88e6af47b1b0f.css"> Please enable JavaScript to continue using this application.

The Georgia Gateway system is being installed across the State over a period of time. These questions are meant to help screen which system is currently managing your benefits. It is important that you enter your correct information to these questions so that you are directed to the correct website. Q7 - I was directed to Georgia Gateway and ...

Georgia Gateway - Homepage Screen. Please note that Georgia Gateway will be unavailable during these times for planned system maintenance. 06:00 pm on Saturday, 05/04/2024 to 11:00 pm on Saturday, 05/04/2024. 09:00 am on Saturday, 05/11/2024 to 02:00 pm on Sunday, 05/12/2024. Obtain benefit and office hours information at the …Get step-by-step instructions up how till use www.gateway.ga.gov to renew my benefits and continue receives Georgia lunch stamps.Due to the end of the Federal Public Health Emergency (PHE), effective July 1, 2023, the ABAWD Work Requirement has been reinstated for all time limited counties. Failure to meet the ABAWD Work Requirement without Good Cause will result in ABAWDs losing SNAP benefits after three months of non-compliance. Login. This page is used to log into your Gateway Account so that you can create a new application, view, renew or report changes to your existing benefits.If you don't already have a Gateway account, you may create one by selecting the "Create an Account" button.To log into your account, select the "Manage My Account/Login" button and type in ... MyACCESS is a portal where Floridians can get and manage benefits online. This includes food assistance (SNAP) formerly food stamps, cash aid (TCA), and affordable health coverage (Medicaid) Georgia Gateway To apply for or renew benefits online; can also be used to report interim changes or check for potential eligibility. Visit Georgia Gateway. Georgia Gateway Support Primary (877) 423-4746: For technical issues with Georgia Gateway. Out of State Placement (ICPC) [email protected] Please note that Georgia Gateway will be unavailable during these times for planned system maintenance: 08:00 pm on Thursday, 03/21/2024 to 11:00 pm on Thursday, 03/21/2024. Don’t risk losing your Medicaid benefits. Renewing your Medicaid eligibility is as easy as 1, 2, 3. You should receive a letter from the State of Georgia a few months before your Medicaid or PeachCare for Kids redetermination date, explaining how to verify your Medicaid eligibility. If you are eligible for Medicaid, you can continue your ... How to Complete Your Redetermination From Your Gateway Account: Find your notification letter or email that has your case number and your client ID. Log into your Gateway account at gateway.ga.gov. Once on the homepage click “Renew Benefits.” From there, fill in the information required and upload any necessary documents. Please note that Georgia Gateway will be unavailable during these times for planned system maintenance. 08:00 pm on Friday, 04/19/2024 to 11:00 pm on Friday, 04/19/2024 ... If you would like to create or access your …

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Please note that Georgia Gateway will be unavailable during these times for planned system maintenance: 08:00 pm on Thursday, 03/21/2024 to 11:00 pm on Thursday, 03/21/2024. ... If you would like to create or access your account to: Renew Benefits; Check Benefits; Upload a Document; Report a Change; View Notices; Select the …Georgia Gateway - Homepage Screen. Please note that Georgia Gateway will be unavailable during these times for planned system maintenance. 08:00 pm on Thursday, 05/02/2024 to 11:00 pm on Thursday, 05/02/2024. 06:00 pm on Saturday, 05/04/2024 to 11:00 pm on Saturday, 05/04/2024. Obtain benefit and office hours information at the websites below. Assistance Partners in your area, call 1-877-423-4746. Visit Georgia Gateway at www.gateway.ga.gov or call 1-877-423-4746. WHAT IS THE GEORGIA GATEWAY CUSTOMER PORTAL? The Georgia Gateway Customer Portal replaces COMPASS as the new self-service web portal for you to manage your benefits online for five programs, including: Georgia Gateway - Homepage Screen. Please note that Georgia Gateway will be unavailable during these times for planned system maintenance. 08:00 pm on Thursday, 05/02/2024 to 11:00 pm on Thursday, 05/02/2024. 06:00 pm on Saturday, 05/04/2024 to 11:00 pm on Saturday, 05/04/2024. Obtain benefit and office hours information at the …When it comes to choosing a payment gateway for your online business, there are many options available. One of the most popular options is Amazon Payment. In this article, we will ...Redetermination is the process that the State of Georgia must follow to make sure current Medicaid and PeachCare for Kids® members are still eligible for coverage. Generally, both Medicaid and PeachCare for Kids® benefits require renewals every 12 months. During redetermination, the State of Georgia will collect and verify your information ...Georgia Gateway - Homepage Screen. Please note that Georgia Gateway will be unavailable during these times for planned system maintenance. 08:00 pm on Thursday, 05/02/2024 to 11:00 pm on Thursday, 05/02/2024. 06:00 pm on Saturday, 05/04/2024 to 11:00 pm on Saturday, 05/04/2024. Obtain benefit and office hours information at the …Georgia Gateway - Homepage Screen. Please note that Georgia Gateway will be unavailable during these times for planned system maintenance. 08:00 pm on Friday, 04/26/2024 to 11:00 pm on Friday, 04/26/2024. Obtain benefit and office hours information at the websites below. Department of Family & Children Services (DFCS) at https://dfcs.georgia ... ….

How to Complete Your Redetermination From Your Gateway Account: Find your notification letter or email that has your case number and your client ID. Log into your Gateway …Are you a devoted reader of the Magnificat magazine? If so, it’s time to consider renewing your subscription. Renewing your Magnificat subscription comes with a myriad of benefits ... Georgia Gateway - Homepage Screen. Please note that Georgia Gateway will be unavailable during these times for planned system maintenance. 08:00 pm on Thursday, 05/02/2024 to 11:00 pm on Thursday, 05/02/2024. 06:00 pm on Saturday, 05/04/2024 to 11:00 pm on Saturday, 05/04/2024. Obtain benefit and office hours information at the websites below. The renewal application must be completed and submitted to the state before the coverage period ends. Georgia residents can also renew their Medicaid coverage online using the Georgia Gateway portal. The Georgia Gateway is a website that allows residents to apply for, renew, and manage their public assistance benefits online.Georgia Gateway is the central, easy way to apply for and get help with assistance in Georgia ... during these times for planned system maintenance. 08:00 pm on Friday, 04/26/2024 to 11:00 pm on Friday, 04/26/2024; Obtain benefit and office hours information at the websites below. ... is an automatic process to enroll or renew eligible children ... Login. This page is used to log into your Gateway Account so that you can create a new application, view, renew or report changes to your existing benefits.If you don't already have a Gateway account, you may create one by selecting the "Create an Account" button.To log into your account, select the "Manage My Account/Login" button and type in ... This video reviews step-by-step instructions on how to reset your password within the Ohio Benefits Self-Service Portal. This is a new feature to eliminate the need to call the help desk for a password reset. 3/6/23. 1:09.We would like to show you a description here but the site won’t allow us.You can renew online through Georgia Gateway. Sign in with your existing login information. Fill out all of the required information and submit your renewal. You will …Georgia Gateway is the central, easy way to apply for and get help with assistance in Georgia ... and you would like to create an account so you can manage your benefits online, click the Create an Account button below. Create an Account. If you would like to create or access your account to: Renew Benefits; Check Benefits; Upload a … Gateway renew my benefits, Medicaid Renewals. ☎ Change Report Center: (302) 571-4900, Option 2. ☎ TTY users: Call 1-855-889-4325. ☎ Español, Kreyòl ayisyen, العربية, Tiếng Việt, or other languages: 1-866-843-7212. Enrollment. ☎ Customer Relations: 866-843-7212 ☎ Provider Relations: 800-999-3371 ☎ Health Benefits Manager: 800-996-9969., TANF Benefit Renewal. All benefits recipients are required to undergo periodic review of continued program eligibility. A renewal form and any required accompanying verification can be submitted in Georgia Gateway or by using Form 508 – the FOOD STAMP/MEDICAID/TANF Renewal Form. English: Form 508 Standard Font. Georgia’s Voter Registration, Please note that Georgia Gateway will be unavailable during these times for planned system maintenance: 08:00 pm on Thursday, 03/21/2024 to 11:00 pm on Thursday, 03/21/2024. ... If you would like to create or access your account to: Renew Benefits; Check Benefits; Upload a Document; Report a Change; View Notices; Select the …, Georgia Gateway - Homepage Screen. Please note that Georgia Gateway will be unavailable during these times for planned system maintenance. 08:00 pm on Thursday, 05/02/2024 to 11:00 pm on Thursday, 05/02/2024. 06:00 pm on Saturday, 05/04/2024 to 11:00 pm on Saturday, 05/04/2024. Obtain benefit and office hours information at the websites below., Select your state from the drop-down below, or use the SNAP state directory, to: Find a local SNAP office to apply for benefits or get help on your case. Go to an online application or download a paper application. Learn when your benefits will be available. Find out where to call for information on your EBT card., It’s that dreaded day far too many months before your apartment lease actually ends: When the renewal notice comes, and you have to decide to stay or go way faster than you wanted ..., Georgia Gateway is the central, easy way to apply for and get help with assistance in Georgia. ... Obtain benefit and office hours information at the websites below. Department of Family & Children ... is an automatic process to enroll or renew eligible children under the age of 19 who are receiving Supplemental Nutrition Assistance Program ..., NASA has announced that SpaceX will take two major parts of the Gateway lunar orbiter that will function as a pit stop for future moon missions. The Power and Propulsion Element an..., You can apply for benefits as well as check and manage your status through Georgia Gateway. Visit the Georgia Gateway website. Create an account or log in with your …, Georgia Gateway is the central, easy way to apply for and get help with assistance in Georgia ... and you would like to create an account so you can manage your benefits online, select the Create an Account button below. Create an Account. If you would like to create or access your account to: Renew Benefits; Check Benefits; Upload a …, Please note that Georgia Gateway will be unavailable during these times for planned system maintenance. 08:00 pm on Friday, 04/19/2024 to 11:00 pm on Friday, 04/19/2024 ... If you would like to create or access your …, Georgia Gateway is the central, easy way to apply for and get help with assistance in Georgia ... and you would like to create an account so you can manage your benefits online, select the Create an Account button below. Create an Account. If you would like to create or access your account to: Renew Benefits; Check Benefits; Upload a …, If you want a Georgia Voter Registration application mailed to you, you may call the Georgia Secretary of State’s office at 404-656-2871, call DFCS’ Customer Contact Center at 877-423-4746, or visit sos.ga.gov. 3. Contact the SNAP Customer Contact Center. Toll-Free: (877) 423-4746. Contact your local DFCS office., Express Lane Eligibility (ELE) is an automatic process to enroll or renew eligible children under the age of 19 who are receiving Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF), Refugee Cash Assistance (RCA), Child Care and Parent Services (CAPS) or Women, Infants and Children (WIC) into the ... , Georgia Gateway is the central, easy way to apply for and get help with assistance in Georgia. ... and you would like to create an account so you can manage your benefits online, select the Create an Account button below. Create an Account. If you would like to create or access your account to: Renew Benefits; Check Benefits; Upload a Document;, Georgia Gateway - Homepage Screen. Please note that Georgia Gateway will be unavailable during these times for planned system maintenance. 08:00 pm on Thursday, 05/02/2024 to 11:00 pm on Thursday, 05/02/2024. 06:00 pm on Saturday, 05/04/2024 to 11:00 pm on Saturday, 05/04/2024. Obtain benefit and office hours information at the websites below. , The Supplemental Nutrition Assistance Program (SNAP), formerly referred to as the Food Stamp Program, is a federally funded program that helps low-income families pay for the cost of food. The SNAP program also provides opportunities to improve their economic standing with job skills training and other support., Georgia Gateway - Homepage Screen. Please note that Georgia Gateway will be unavailable during these times for planned system maintenance. 08:00 pm on Thursday, 05/02/2024 to 11:00 pm on Thursday, 05/02/2024. 06:00 pm on Saturday, 05/04/2024 to 11:00 pm on Saturday, 05/04/2024. Obtain benefit and office hours information at the websites below., How to Complete Your Redetermination From Your Gateway Account: Find your notification letter or email that has your case number and your client ID. Log into your Gateway …, Setting Up An Account. To apply online, you will need to create a User ID and password. If you already have an account, select here to log in. This account will help to keep your information private and secure. It also lets you save your application and come back to …, Just follow these easy steps to renew your benefits now. 1. Keep an eye out for a notice in the mail. You’ll get a renewal notice from Georgia Gateway in the mail. 2. Go to the Georgia Gateway website. Log in or create an create an account. 3. …, To renew your Gateway GA food stamps benefits, you will need to complete an application form. You can find the application form on the Georgia Department of Human Services website. After completing your application, you will need to submit it either in person at a local Department of Human Services office, or mail it to the Division of Family ..., Georgia Gateway - Homepage Screen. Please note that Georgia Gateway will be unavailable during these times for planned system maintenance. 08:00 pm on Friday, 04/26/2024 to 11:00 pm on Friday, 04/26/2024. Obtain benefit and office hours information at the websites below. Department of Family & Children Services (DFCS) at …, Georgia Gateway is the central, easy way to apply for and get help with assistance in Georgia ... and you would like to create an account so you can manage your benefits online, select the Create an Account button below. Create an Account. If you would like to create or access your account to: Renew Benefits; Check Benefits; Upload a …, Georgia Gateway - Homepage Screen. Please note that Georgia Gateway will be unavailable during these times for planned system maintenance. 08:00 pm on Thursday, 05/02/2024 to 11:00 pm on Thursday, 05/02/2024. 06:00 pm on Saturday, 05/04/2024 to 11:00 pm on Saturday, 05/04/2024. Obtain benefit and office hours information at the …, Account. Use the portal to pay your premium, check your deductible, change your. doctor, request an ID Card and more. My CareSource Login., GA Gateway Customer Server Phone Number. For more help with your Georgia Gateway online account otherwise for assistance renewing insert food stamps, please call the GA Gateway Patron Service phone number below: Georgia Gateway Customer Service Phone Number (Toll-Free): 1-877-423-4746., GA Gateway Customer Server Phone Number. For more help with your Georgia Gateway online account otherwise for assistance renewing insert food stamps, please call the GA Gateway Patron Service phone number below: Georgia Gateway Customer Service Phone Number (Toll-Free): 1-877-423-4746., Georgia Gateway is the state’s integrated system for determining eligibility across multiple benefits programs. These programs include Medical Assistance (Medicaid, PeachCare …, Georgia Senior SNAP P.O. Box 450149Atlanta, GA 31145-0149Fax: 678-717-5585. All Senior SNAP inquiries are routed to the DFCS Customer Contact Center main number (877) 423-4746. Self-service application options: Online: Log on to Georgia Gateway at gateway.ga.gov/ to apply for benefits. , Are you a frequent shopper at Sam’s Club? If so, you may already know about the incredible savings and wide range of products available at this popular warehouse store. Sam’s renew..., Please note that Georgia Gateway will be unavailable during these times for planned system maintenance: 01:00 pm on Saturday, 07/08/2023 to 09:00 pm on Saturday, 07/08/2023. ... If you would like to create or access your account to: Renew Benefits; Check Benefits; Upload a Document;, Self-service application options: Online: Log on to Georgia Gateway at https://gateway.ga.gov/ to apply for benefits. Available 24/7. By Phone: Call the Customer Contact Center at (877) 423-4746 to submit an application by telephone. An application is considered filed when it has the name of the head of household, address, date and signature of ...