How to Complete a Proxy Form for CSFP Pickup
This document provides instructions for filling out a proxy form for the Commodity Supplemental Food Program (CSFP). It outlines the necessary steps for seniors to designate a proxy to pick up their food benefits. Ensure you follow these guidelines to successfully complete the form.
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How do I fill this out?
Filling out the proxy form is straightforward and essential for ensuring the proper pickup of food benefits. Begin by clearly entering the client’s name and the designated agency for pickup. Ensure both the client and the proxy sign the form before submission.
How to fill out the How to Complete a Proxy Form for CSFP Pickup?
1
Fill in the client name and mark the CSFP program box.
2
Specify the agency from which the proxy will collect the CSFP box.
3
Both the client and proxy must sign the form.
4
Email or fax the completed form to the designated contacts.
5
Retain a copy for your records.
Who needs the How to Complete a Proxy Form for CSFP Pickup?
1
Seniors who are unable to pick up food benefits due to health issues.
2
Family members designated to assist elderly clients with their food benefits.
3
Caregivers managing multiple senior clients at the same location.
4
Site managers coordinating food pickups for a group of seniors.
5
Community organizations facilitating access to food benefits for clients.
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What are the instructions for submitting this form?
To submit the proxy form, you can either scan and email it to kbacher@foodbankrockies.org or fax it to 720-473-6328. Alternatively, you can also deliver it in person to the CSFP pick-up site. Ensure to retain a copy of the completed form for your records to avoid any discrepancies.
What are the important dates for this form in 2024 and 2025?
For the year 2024, all proxy forms filed will need to be renewed by June 30, 2025. Ensure all proxies are assigned before the expiration to avoid any disruption in service.
What is the purpose of this form?
The purpose of this form is to empower seniors to designate a trustworthy individual who can collect food benefits on their behalf. This is especially critical for those unable to attend pickup locations in person due to health or mobility issues. By filling out this form, seniors can continue to receive vital food assistance without interruption.
Tell me about this form and its components and fields line-by-line.
- 1. Client Name: The name of the senior client receiving benefits.
- 2. Program: Checkbox indicating the CSFP program.
- 3. Agency Name: The name of the agency from where benefits will be picked.
- 4. Proxy Name: Person designated by the client to pick up the benefits.
- 5. Client Signature: Signature of the client confirming the designation.
- 6. Proxy Signature: Signature of the proxy to validate their authorization.
What happens if I fail to submit this form?
Failure to submit this form can result in delayed or denied access to essential food benefits. Clients may miss out on the opportunity to receive their food distribution if the form is not completed accurately and on time.
- Delay in Food Benefits: Clients may face delays in receiving food benefits if the proxy form is not submitted.
- Denial of Proxy Designation: Without a submitted form, proxies cannot legally collect food benefits.
- Ineligible Proxies: If the form is not submitted, proxies not listed cannot assist in food pickups.
How do I know when to use this form?
- 1. Seniors Lacking Mobility: For seniors who are unable to travel to food distribution centers.
- 2. Support from Family/Caregivers: When family members assist in logistics for food pickups.
- 3. Coordinated Community Efforts: When community services manage food distribution for multiple clients.
Frequently Asked Question
How can I fill out the proxy form?
You can fill out the proxy form using our online editor, ensuring all required fields are completed.
Is there a limit to the number of proxies I can designate?
Yes, each client can designate up to two proxies.
How long is the proxy form valid?
The proxy form is valid for one calendar year from the date of submission.
What if I need to change my designated proxy?
You can submit a new proxy form at any time to update your designated proxy.
Can a proxy represent multiple clients?
Yes, a proxy can represent up to 15 senior clients.
What happens if I submit an incomplete form?
An incomplete form may delay the pickup of food benefits.
Do both client and proxy need to sign?
Yes, both parties must sign the form for it to be valid.
Where can I send the completed form?
You can email, fax, or deliver it in person to the designated agency.
What should I do if I have more questions?
For additional questions, contact the CSFP representative listed in the instructions.
Can seniors pick up their box if they have a proxy?
Yes, either the senior client or the proxy can pick up the box.
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