Wisconsin FoodShare (SNAP) Application

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{
  "id": "spec-wisconsin-foodshare-snap-application-3",
  "title": "Wisconsin FoodShare (SNAP) Application",
  "description": "",
  "groups": [
    {
      "id": "group-new-192f8be6",
      "title": "Application Information and Signature",
      "requirements": [
        {
          "id": "application-date",
          "fieldName": "application_date",
          "label": "Application Date",
          "fieldType": "date",
          "required": true,
          "helpText": "The date this application is being submitted"
        },
        {
          "id": "perjury-certification",
          "fieldName": "i_certify_under_penalty_of_perjury_that_",
          "label": "I certify under penalty of perjury that all information provided in this application is true and complete to the best of my knowledge",
          "fieldType": "boolean",
          "required": true,
          "control": "checkbox"
        },
        {
          "id": "benefit-use-understanding",
          "fieldName": "i_understand_that_i_must_use_foodshare_b",
          "label": "I understand that I must use FoodShare benefits only to purchase eligible food for my household",
          "fieldType": "boolean",
          "required": true,
          "control": "checkbox"
        },
        {
          "id": "false-info-understanding",
          "fieldName": "i_understand_that_providing_false_inform",
          "label": "I understand that providing false information is subject to prosecution under state and federal law",
          "fieldType": "boolean",
          "required": true,
          "control": "checkbox"
        },
        {
          "id": "rights-responsibilities-ack",
          "fieldName": "i_acknowledge_that_i_have_received_and_u",
          "label": "I acknowledge that I have received and understand my rights and responsibilities under the FoodShare program",
          "fieldType": "boolean",
          "required": true,
          "control": "checkbox"
        },
        {
          "id": "verification-authorization",
          "fieldName": "i_authorize_the_state_agency_to_verify_t",
          "label": "I authorize the State agency to verify the information I have provided through collateral contacts, computer matches, and other means permitted by law",
          "fieldType": "boolean",
          "required": true,
          "control": "checkbox"
        },
        {
          "id": "applicant-printed-name",
          "fieldName": "applicant_full_name_(print)",
          "label": "Applicant Full Name (Print)",
          "fieldType": "text",
          "required": true,
          "helpText": "Print the full name of the person signing this application"
        },
        {
          "id": "applicant-signature",
          "fieldName": "applicant_signature",
          "label": "Applicant Signature",
          "fieldType": "text",
          "required": true,
          "helpText": "Digital signature of the applicant or authorized representative. By typing your name here, you are providing your electronic signature."
        },
        {
          "id": "signature-date",
          "fieldName": "signature_date",
          "label": "Signature Date",
          "fieldType": "date",
          "required": true,
          "helpText": "Date the application was signed"
        },
        {
          "id": "is-authorized-rep",
          "fieldName": "is_this_application_being_signed_by_an_a",
          "label": "Is this application being signed by an authorized representative on behalf of the household?",
          "fieldType": "boolean",
          "required": true,
          "control": "radio"
        },
        {
          "id": "auth-rep-name",
          "fieldName": "authorized_representative_name",
          "label": "Authorized Representative Name",
          "fieldType": "text",
          "required": false,
          "helpText": "Full name of the authorized representative if different from applicant"
        },
        {
          "id": "auth-rep-relationship",
          "fieldName": "relationship_to_household",
          "label": "Relationship to Household",
          "fieldType": "text",
          "required": false,
          "helpText": "How is the authorized representative related to or connected to the household?"
        },
        {
          "id": "auth-documentation",
          "fieldName": "authorization_documentation",
          "label": "Authorization Documentation",
          "fieldType": "longText",
          "required": false,
          "helpText": "Describe the documentation provided establishing authority to act for the household (signed statement, power of attorney, court documentation, etc.)"
        }
      ]
    },
    {
      "id": "group-new-d2a399b5",
      "title": "Household Information",
      "requirements": []
    },
    {
      "id": "group-new-1c3a17f7",
      "title": "Employment and Income",
      "requirements": []
    },
    {
      "id": "group-new-e5fd9e9d",
      "title": "Resources and Assets",
      "requirements": []
    },
    {
      "id": "group-new-cb66747f",
      "title": "Housing and Shelter Costs",
      "requirements": []
    },
    {
      "id": "group-new-a56f8163",
      "title": "Medical and Dependent Care Expenses",
      "requirements": []
    },
    {
      "id": "group-new-f5847b49",
      "title": "Student and Work Requirements",
      "requirements": []
    },
    {
      "id": "group-new-fd543e9e",
      "title": "Authorized Representative",
      "requirements": []
    },
    {
      "id": "group-new-dd5d95ee",
      "title": "Rights and Responsibilities",
      "requirements": []
    }
  ]
}