Rule 18-14-34.3 - Household Statement of LossA. Prior to issuing a replacement, MDHS must obtain from a household member a signed statement attesting to the household's loss.B. The statement of loss will attest to the destruction of food purchased with the original issuance and the reason for the replacement.C. The statement of loss will also attest to the fact that the household is aware of the penalties for intentional misrepresentation of the facts including a charge of perjury for a false claim.D. The household statement of loss may be mailed if the household member is unable to come to the office due to age, handicap or distance and is unable to appoint an authorized representative.E. If the signed statement or affidavit is not received by MDHS within 10 days of the date of the report, no replacement will be made.F. If the 10th day falls on a holiday or weekend and the statement is received by MDHS the next business day, MDHS will consider the statement timely received.G. The household statement of loss must be retained in the case record.18 Miss. Code. R. 14-34.3