209.37 Verification of Deprivation SR 12-30, 08/12 (FAM-A)

Verify any of the three causes which deprive a child of parental support or care. Also verify the parent-child relationship.

The following special verification requirements must be met:

Deprivation due to death: Use any document that reasonably proves the 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 at initial application only.

Deprivation due to continued absence: The individual must complete DFA Form 773, Certification of Continued Absence. Verify continued absence using DFA Form 773 at initial application, whenever continued absence is questionable, and *when appropriate (such as when the 30-days have been broken).

Deprivation due to incapacity: Verify incapacity with the following:

• if the individual is currently eligible for or receiving APTD, ANB, or SSI or SSA disability benefits, the individual must complete and sign DDU Form 177, Non-Medical Evaluation of Disability, and DDU Form 940, Cover Memo for Medical Eligibility Information. Verify status at initial application and each redetermination of eligibility;

• if the individual is NOT currently receiving APTD, ANB, SSI or SSA, use the following verification process:

- the individual must complete and sign DDU Form 177;

- complete DDU Form 177a, Interview Observations;

- provide the individual with DFA Form 720, Determination of Incapacity Status, for completion by their physician or psychologist;

- set a review date for the end of the incapacity (as stated on the DFA Form 720) or for the first redetermination, whichever is earlier; and

- verify incapacity at initial application, each redetermination of eligibility, and whenever a change in incapacity occurs.

A completed DFA Form 720 includes:

• the individuals dated and witnessed signature;

• a statement by a physician or psychologist which indicates whether an incapacity exists, and if it does exist:

- the date when the incapacity began, ended, or is expected to end; and

- the diagnosis, examination date, and current and recommended medical treatment; and

• the name, address, phone number, specialty, and dated signature of the physician or psychologist.

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