Submit Date 05/14/2025
Submit Time 03:27 PM EST
Application Summary
Programs Food Assistance (SNAP)
Your Information
Main Applicant Patricia Foord (51)
What language do you prefer to read? English
What language do you prefer to speak? English
Do you need an interpreter? No
First Name Patricia
Middle Name M
Last Name Foord
Suffix
Other Names Patricia Kelly
Are you a person who is blind or visually No
impaired?
Visual assistance needed
Are you a person who is deaf or hard of No
hearing?
Hearing assistance needed
Are you a resident of Florida? Yes
Are you applying for benefits for yourself? Yes
Do you want to allow the authorized
representative to get and spend benefits for
you?
Living Situation
Date child removed
Date child returned
What is Patricia address before entering the
Nursing home?
Name of contact person who can verify
information
Relationship
Address of the person who can verify
information
Are you experiencing homelessness? Yes
Which city are you currently in? Port Richey
What state are you currently in? Florida
What's the zip code where you are currently 34668
staying?
Temporarily Mailing Address 11115 Us Hwy 19 #229,Port Richey,Florida,34668
Where do you currently live?
Do you get your mail at a different address?
Where do you receive your mail?
Home Phone
Mobile Phone (727) 379-7524
Work Phone/Alternate Phone
Email trishakellyfoord1@gmail.com
Would you like to get text messages about
your benefits?
Would you like to receive email notifications Yes
instead of paper mail?
Date of Birth 12/21/1973
What's your gender? Female
Do you have a Social Security number? Yes
What's your Social Security number? 047-64-8153
Why don't you have a Social Security number?
Please explain.
Have you applied for an Social Security
number?
Have you ever used a different Social Security No
number?
What Social Security number have you used?
SSN Type
First Name
Last Name
Name Type
Marital Status Divorced
In what country were you born? United States
Have you been outside of the U.S. in the last 30 No
days?
Are you a U.S. citizen or national? Yes
Date Entered U.S. (if you know)
Date Left the U.S. (if you know)
Immigration Document Type
Immigration Document Number
Date Document Issued by USCIS (if you know)
Have you lived in the U.S. continuously since
1996?
Are you a spouse or parent of a veteran or an
active-duty member of the U.S. military?
Have you been granted asylum in the U.S.?
Date Asylum Granted
Have you had a medical emergency in the U.S.
in the past 3 months?
Type
Date
Are you a sponsored noncitizen?
Type
Sponsor ID
Name
Phone
Do you have, applied for, or plan to apply for
the following: T-Visa, U-Visa, Violence Against
Women Act (VAWA) petition
Did your immigration status change in the last
12 months?
What's changed?
Date of Change
Alien Number
Are you of Hispanic, Latino, or Spanish origin? No
What is your race? White
Are you a member of a federally recognized
tribe?
Tribe Name
Did you ever get a service from, or did
someone refer you to, Indian Health Service or
Tribal Health Programs?
Are you eligible to get services from the Indian
Health Services, tribal health programs or
through a referral from one of these
programs?
People
People
Do you have other people living in your No
household?
Assets
Checking Account Patricia Foord (51)
Amount $ 0.00
Where Held NFCU
Is this jointly owned? No
What percentage do they own? 0.0%
Will a part of the value of this asset pay for
future burial costs?
If yes, how much?
Savings Account Patricia Foord (51)
Today's Balance $ 0.00
Bank/Credit Union NFCU
Is this jointly owned? No
What percentage do they own? 0.0%
Will a part of the value of this asset pay for
future burial costs?
If yes, how much?
Cash Patricia Foord (51)
Today's Balance $ 15.00
Is this jointly owned? No
What percentage do they own? 0.0%
Will a part of the value of this asset pay for
future burial costs?
If yes, how much?
Other Situations
Additional Programs & Services
Select the programs you want to add to your Lifeline Assistance
application, if any.
Child Health and Disability Prevention
Who is Limited in ability to do things most
children of the same age can do?
Who Needs special therapy for emotional,
developmental or behavioral problems?
Who Needs or uses medical, mental or
educational services other than usual for
children of the same age?
Who Would like to get child health check up
services?
Lifeline Assistance
Do you feel that your current living situation is
unsafe for you or another family member, for
any reason?
Can we refer you for help?
Do you want discounted phone service No
(Lifeline Assistance)?
Do you have phone service?
Whose name is on the phone bill?
Phone Company Name
Your Phone Number
Address Type
Convictions and Felony
Convicted of receiving duplicate food No
assistance,Medicaid, or Cash Assistance in any
state after 08/22/1996?
Convicted of sharing or selling EBT cards No
worth $500 or more after 08/22/1996?
Found guilty of Drug Trafficking or trading No
food assistance for drugs in any state after
08/22/1996?
Found guilty of trading food assistance for No
guns, ammunitions, or explosives after
Hiding or running from the law for a felony No
crime or attempted felony crime? (This could
be to avoid prosecution, being taken into
custody, or going to jail.)
Aggravated sexual abuse, murder, sexual No
exploitation and other related abuse of
children, Federal or State offense involving
sexual assault, or an offense under state law
similar to crimes listed, after February 7,
2014?
Review & Submit
Review & Submit
Is there anything else you would like us to I am currently homeless & have no living family members to help me out.
know? I would greatly appreciate emergency assistance with food as soon as
possible. Thank you for your time.
Do you want to register to vote at your current No, I don’t want to register
address
Do you give permission to DCF to request your
financial records, to confirm the asset
information provided?
Main Applicant Signature
First Name Patricia
Last Name Foord
Date 05/14/2025
I confirm that I read, or had read to you, and Yes
understand and agree to the Rights and
Responsibilities.
