This document outlines the eligibility requirements for Mississippi's Emergency Food Assistance Program (TEFAP) from October 1, 2019 to September 30, 2020. Applicants must either have a household income at or below the levels listed or participate in programs like SNAP, TANF, or SSI. The form collects the applicant's name, address, phone number, income, and household size. It lists income eligibility guidelines and requires the applicant's signature to certify their eligibility. The form is valid for one year and any changes must be reported immediately.