Indiana
Indiana Application for SNAP and Cash Assistance (state form 53263)
No One Left Outside provides source-based information. The issuing agency or plan decides eligibility, acceptance and availability.
Source / last checked DFR: Forms - 2026-11-02
- Form number
- 53263
DFR: Forms - Reviewed 2026-11-02
- What it is for
- Indiana Application for SNAP and Cash Assistance (state form 53263)
DFR: Forms - Reviewed 2026-11-02
- Issuing agency
- Indiana Family and Social Services Administration (FSSA); this form appears in the DFR forms catalog.
DFR: Forms - Reviewed 2026-11-02
- Program
- SNAP and cash assistance
DFR: Forms - Reviewed 2026-11-02
- Jurisdiction
- Indiana
DFR: Forms - Reviewed 2026-11-02
- Category
- SNAP
Indiana Application for SNAP and Cash Assistance (state form 53263) - Reviewed 2026-11-02
- Form type
- form
DFR: Forms - Reviewed 2026-11-02
- Who fills it out
- If you are completing this application on behalf of someone else and you do not live in their household, please provide your name below and your contact information in Section 7. If you are completing this application on behalf of someone else and you do live in their household, please provide your information in Section 9:
Indiana Application for SNAP and Cash Assistance (state form 53263) - Reviewed 2026-11-02
- How to submit
- General DFR forms-catalog route: fax 888-436-9199, or deliver or mail to your local county office. Follow document-specific instructions where supplied.
DFR: Forms - Reviewed 2026-11-02
- Documents to include
- NOTE: If you are a representative for the person(s) needing assistance, the applicant must complete and sign the enclosed Authorized Representative form.
Indiana Application for SNAP and Cash Assistance (state form 53263) - Reviewed 2026-11-02
- Languages
- English
Indiana Application for SNAP and Cash Assistance (state form 53263) - Reviewed 2026-11-02
- Official page
- https://www.in.gov/fssa/dfr/forms-documents-and-tools/forms
DFR: Forms - Reviewed 2026-11-02
- Direct form link
- https://forms.in.gov/Download.aspx?id=12306
DFR: Forms - Reviewed 2026-11-02
- Revision date
- R10 / 3-16
Indiana Application for SNAP and Cash Assistance (state form 53263) - Reviewed 2026-11-02
- Signature
- INSTRUCTIONS: Please fill out your application as completely as you can. It will help if you can answer all of the questions. However, the application will be valid if you provide name(s), address, and signature. To be considered for expedited SNAP (Food Assistance) service you must complete all of Section 8. Please do not forget to sign your application on Page 1 Section 3.
Indiana Application for SNAP and Cash Assistance (state form 53263) - Reviewed 2026-11-02
- Accessibility
- Please indicate if you need the following interpreter services for your application interview appointment: Language interpreter Language Sign Language interpreter
Indiana Application for SNAP and Cash Assistance (state form 53263) - Reviewed 2026-11-02
- What the form says
I certify under penalty of perjury, all information I have given on this application, any attachments and information provided during the eligibility determination process is complete and correct to the best of my knowledge and belief, including the citizenship or immigration status of each applicant.
Indiana Application for SNAP and Cash Assistance (state form 53263) - Reviewed 2026-11-02
Check the form number and revision before using it. Read the agency's privacy and consent terms before sharing personal information.