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2) Age. {Must be 60 years of age at time of application) <br />3) The participant's first name, middle initial and last name. <br />4) The address is complete. with street address, city, state; and z~ <br />code. <br />5) The county in which the participant resides. <br />6) The phone number with area code listed. <br />7) The participant must indicate his ethnicity or race; provide guidance <br />when participant does not. <br />8) It applicable, include the Proxy's name, relationship to the <br />participant, proxy's phone number, and a proxy identification <br />number (State ID ordriver license number). <br />9) The participant's signature verifying their eligibility for the program <br />and the proxy's signature, if applicable. An application signed only <br />by the proxy can not be processed. ' <br />10) The date: <br />11) The distribution site <br />c. The Distribution Agent will then ensure that the.Applicant is within the <br />. Eligibility guidelines of the program (Age 60, income at or below 185% <br />Federal Poverty Rate, has not received SFMNP coupons for the program <br />this year and is an Ohio Resident), After doing this, the Distribution Agent <br />will then record on the back of the Application if the Applicant is eligible <br />for coupons and will receive coupons, if they are eligible and will be wait <br />listed or if the applicant is not eligible and the reason why. <br />11: After eligibility has been determined and recorded by the Distribution Agent, <br />the Distribution Agent will then issue the Applicant a letter of response to their <br />application (via a form letter provided by the WRAAA for the Distribution Agent}. <br />This letter will include the following information: <br />a. Participant Name.. <br />b. Date of Application. <br />c. Eligibility status {eligible and receive coupons, eligible and waiting <br />list, or not eligible and reason}. <br />Page 4 of 7 <br />