209.37 Verification of Deprivation SR97-09, 03/97 (FAM-A)

Verify any of the four causes which deprive a child of parental support or care. Use any document which reasonably proves the deprivation. Also verify the parent-child relationship. The following special requirements must be met:

Deprivation due to death: An affidavit of death used as verification must consist of signed statements by two individuals who have direct knowledge of the death. Verify the death one time, at initial determination only.

Deprivation due to continued absence: The individual must complete Form 773, Certification of Continued Absence. Verify continued absence at initial determinations and redeterminations.

Deprivation due to incapacity: OMS determines incapacity based on District Office documentation and reports on Form 940, Cover Memo for Medical Eligibility Information. OMS provides a determination for the initial interview and when required by changes in the incapacitated parent’s medical or employment status.

At the initial determination interview, start the verification process with the following, unless the individual is currently receiving SSI or SSA based on disability:

• Assist the applicant in completing Form 177, Social Information, the applicant must sign the form.

• Complete Form 177a, Interview Observations.

• Provide the individual with Form 921 for completion by their physician or psychologist. If the applicant currently receives SSA or SSI disability benefits, Form 921 is not required.

• If the applicant does not return a Form 921 that clearly defines a qualifying disability:

- for physically incapacitated parents, issue the applicant Form 915, Medical Evaluation Initial. *

- for mentally incapacitated parents, issue Form 920, Psychiatric Evaluation Initial.

 Send returned verification to OMS.

• Assist the applicant in completing Form 11, Applicant’s Authorization to Release Information, when it is necessary to obtain additional information.

• Gather additional information requested by OMS on Form 940. OMS will remain responsible for gathering additional medical data directly from a physician or institution.

• Gather any additional material which may bear on a decision.

Deprivation due to unemployment: For initial determination, the applicant must provide verification of the following:

• the earnings of each parent for the preceding 24 months prior to the month of application for assistance.

• the number of hours the PWE worked—or anticipates working—within the appropriate 30-day time frame(s) which establish status as unemployed.

• good cause for the PWE’s refusing a true offer of employment or training.

• the work or education history of the PWE.

• the unemployment compensation history of the PWE.

• a PWE’s willingness to apply for and accept unemployment compensation, if eligible.

For continuing eligibility, the individual must provide verification of the following:

• the number of hours the PWE worked in a given month and the anticipated hours of employment for the following month.

• a PWE’s willingness to apply for and accept unemployment compensation benefits, if newly eligible.

When an individual has no way of obtaining written documentation of work or education history, accept the individual’s written declaration, unless you have reason to believe the declaration is inaccurate.

Failure to comply: Failure to comply with verification requests results in the denial of TANF financial and medical assistance for the entire case.