Utah DWS Form 702, the Statement of Contribution, is the document the Department of Workforce Services uses to record money or bill payments someone outside your household provides on your behalf. Your caseworker uses it to decide whether that help counts as income when calculating your SNAP, Medicaid, or other assistance benefits. Both you and the person helping you fill it out, both of you sign, and you return it through myCase, fax, mail, or in person.
When You’ll Be Asked for Form 702
DWS requests the form any time a third party pays a household expense for you or gives you cash toward living costs. The Medicaid Policy Manual lists Form 702 as an acceptable way to verify “payment of household expenses by others.”1DHHS – Medicaid Policy Manual. Table VIII – Verifications and Interface Match Typical situations: a parent pays your rent directly to the landlord, a friend covers a utility bill, a relative hands you cash each month for groceries.
Expect the request at your initial application, at a periodic review, or whenever you report new outside support mid-certification. Under Utah Administrative Code R986-100-113, you have to report material changes that could affect eligibility and complete the review forms DWS sends you.2Utah Administrative Rules. Utah Admin Code R986-100-113 – A Client Must Inform the Department of All Material Changes
Will the Contribution Reduce Your Benefits?
Not every gift counts as income for SNAP, and the distinction turns on where the money comes from and how it reaches you. If someone uses their own money to pay one of your bills directly, such as writing a check to your landlord, that payment is excluded from your household income under federal SNAP rules. If money legally owed to you (like wages) is diverted to a third party to cover an expense, it counts as income even though you never handled the cash.3eCFR. 7 CFR 273.9 – Income and Deductions Cash handed to you is generally treated as unearned income no matter who gave it to you.
Utah’s SNAP program weighs both household income and assets in deciding eligibility.4Utah Department of Workforce Services. SNAP – The Supplemental Nutrition Assistance Program (Food Stamps) If a contribution pushes you over the limit, your monthly benefit may drop or end. That’s why accuracy on the form works in your favor: the details let your caseworker apply the right rule instead of treating everything as countable income.
Getting the Form
Form 702 isn’t on the DWS Customer Education Center’s public forms page,5Utah Department of Workforce Services. Customer Education Center Forms so a website search probably won’t turn it up. Your caseworker will send it through your myCase account, hand it to you at an office visit, or include it in a mailed verification request. If you’ve been told to submit one but don’t have a copy, call your caseworker or stop by your nearest DWS employment center.
Filling Out Form 702
The form gathers information from two people: you, and the contributor. Before you start, make sure the contributor is reachable, because both of you have to sign.
Identifying Information
Enter full legal names, current residential addresses, and phone numbers for yourself and the contributor. Use the name that matches your government ID so it lines up with what DWS already has on file. If the contributor recently moved, use their new address.
Contribution Details
This section carries most of the weight. Include:
- The exact dollar amount contributed each time, not a rough estimate.
- The frequency: one-time, weekly, monthly, or some other schedule.
- The type of help: cash given to you, rent paid to your landlord, utilities covered, groceries purchased, or something else.
- The payment route: whether the contributor pays you directly or sends money to a third party on your behalf. This detail is what determines whether DWS counts the contribution as income, so get it right.
Signatures and Case Number
Both you and the contributor must sign and date the form. A form missing either signature won’t be accepted as valid verification. If the contributor lives far away, coordinate early so signatures don’t hold you past your verification deadline.
Write your DWS case number on the form. Without it, the imaging center may not be able to match the document to your file, and processing stalls. The case number appears on any notice DWS has sent you, and it’s visible in your myCase account.
Submitting the Completed Form
DWS accepts Form 702 three ways. Choose the one that beats your deadline.
Upload Through myCase
Sign in at jobs.utah.gov/mycase-app/ui/ and check for pending verification requests on the home screen. Upload the form through the documents section. Scan or photograph it clearly so every field and both signatures are legible.
Mail or Fax
Mail the form to DWS Imaging Operations:6Utah Department of Workforce Services. Eligibility Services Contact
Imaging Operations
P.O. Box 143245
Salt Lake City, UT 84114-3245
For faster delivery, fax it to 801-526-9500 in the Salt Lake area or 1-877-313-4717 toll-free.6Utah Department of Workforce Services. Eligibility Services Contact Keep the fax confirmation as proof.
Drop Off in Person
Any local DWS employment center will take the form at the front desk. Bring a copy for yourself and ask for a receipt or timestamp. This is the safest option when your deadline is today.
What Happens After You Submit
Your caseworker reviews the Statement of Contribution against the rest of your financial information and recalculates your household’s countable income. If the contribution doesn’t push you past the eligibility limits, your benefits hold steady or shift only slightly. If it does, DWS sends a formal notice explaining the change to your amount or status.
Caseworkers sometimes contact the contributor directly to confirm the information, particularly if the amounts are large or details don’t match other records. They may also ask for bank statements. Answer these follow-ups on time; missing a verification deadline lets DWS reduce or close your benefits based on what it already has.
If you haven’t heard anything within 30 days of sending in the form, call your caseworker to confirm the document reached your file.
Penalties for False Information
Misrepresenting the amount, frequency, or nature of a contribution can trigger serious consequences. Utah treats benefit fraud as a criminal matter, and false statements made to obtain public assistance can lead to prosecution, disqualification, overpayment recovery, and other monetary penalties.7Utah Department of Workforce Services. Penalty for Fraud
Federal law adds escalating SNAP disqualifications for intentional program violations: one year for a first violation, two years for a second, and permanent disqualification for a third.8Office of the Law Revision Counsel. 7 USC 2015 – Eligibility Disqualifications Those penalties apply only to the person who committed the violation; other household members keep their own eligibility. DWS will also calculate the overpayment and pursue repayment, and federal rules allow the agency to look back up to six years before the problem was discovered.9eCFR. 7 CFR 273.18 – Claims Against Households
A Note on Taxes
Money a friend or relative gives you for living expenses is generally not taxable income under federal law. The IRS treats these transfers as gifts, and recipients don’t owe income tax on gifts. The giver handles any gift tax obligation, and the annual exclusion of $19,000 per recipient in 2026 keeps most informal support out of any filing requirement.10Internal Revenue Service. Frequently Asked Questions on Gift Taxes
The IRS and DWS define income differently. A cash gift from your mother can be tax-free and still count as unearned income for SNAP. Report it on Form 702 either way.