SR 05-07 Dated 12/05

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR releases the following forms-related changes:

§   revisions to Form 13, Reimbursement of Death Expenses, to reflect that it is now used only by the Division of Family Assistance (DFA) to provide reimbursement for costs related to a cash recipient’s death;

§   revisions to Form 808, Proof Needed to Determine Your Assistance, to add the child support application to the list of required verifications that are identified on the form; and

§   the obsolescence of the following forms and their associated instructions:

-   Form 205, Notice of Underpayment or Overpayment, and Form 205(i), Instructions for Form 205: Recoupment or Corrective Payment;

-   Form 205A, Payment Adjustment Summary, and Form 205A(i), Instructions for Form 205A; and

-   Form 805, Notice of Decision, and Form 805(i), Instructions for Form 805.

FORMS REVISIONS

Form 13, Reimbursement of Death Expenses

In the past Form 13, Reimbursement of Death Expenses, formerly known as Form DW-13, Vendor Authorization and Statement, was used in three ways:

§   by the former Office of Social Services, as an invoice by which attorneys could bill the Department for providing legal representation on adult services or child and family services cases;

§   by the former Office of Medical Services as a reimbursement request for general medical transportation; and

§   by DFA for reimbursement of burial expenses.

Because billing for legal representation and reimbursement for general medical transportation have been automated, the form is now only used by DFA for reimbursement of expenses related to the death of a cash recipient. The form and its instructions were revised accordingly to focus on the reduced functionality. Additionally, the form will now only be available electronically as its usage has greatly diminished.

Form 808, Proof Needed to Determine Your Assistance

As indicated in the Director’s Memo dated 9/16/04, subject line, "Form 725, Application for Child Support Services Standard Operating Procedure," it has always been a condition of eligibility that applicants for TANF financial and/or medical assistance assign child support rights to the Division of Child Support Services (DCSS). Adding the need for applicants to complete and sign the child support application, Form 725, Application for Child Support Services, to Form 808, Proof Needed to Determine Your Assistance, which is enclosed with the Form 725 when it is mailed to the applicant, ensures that this eligibility condition is emphasized and the proper verifications are returned.

FORMS OBSOLESCENCE

Forms 205, Notice of Underpayment or Overpayment, and companion Form 205A, Payment Adjustment Summary, were no longer used once New HEIGHTS began automatically generating client letters BV0019, Demand Letter for Overpayment, and BI0003, Notice of Underpayment. With the release of this SR, Forms 205 and 205A can be officially obsoleted.

Form 805, Notice of Decision, and its instructions were superseded by the New HEIGHTS NOD enhancements project. The forms’ obsolescence were inadvertently overlooked during the release of SR 02-26 dated June 1, 2002.

POLICY MANUAL REVISIONS

Revised Family Assistance Manual Topics

PART 139    NOTICES OF DECISION (NOD)

PART 149    MASS CHANGES

Section 619.01    Determine the Corrective Payment or Supplemental Benefit

PART 621    RECOUPMENT/REPAYMENT OF ASSISTANCE

Section 621.03    Rate and Method of Recoupment

Section 703.23    Notice of Decision (NOD)

Section 705.01    Outstanding Expenses Covered by Last Payment

Section 705.03    Funeral and Disposal Expenses

Revised Adult Assistance Manual Topics

PART 133    NOTICES OF DECISION (NOD)

PART 147    MASS CHANGES

Section 629.01    Determine the Corrective Payment

Section 631.03    Rate and Method of Recoupment

Section 701.01    Outstanding Expenses Covered by Last Payment

PART 703    FUNERAL AND DISPOSITION EXPENSES

Revised Food Stamp Manual Topics

PART 139    NOTICES OF DECISION (NOD)

PART 149    MASS CHANGES

IMPLEMENTATION

The new version of Form 13 will be electronically transmitted to each District Office with the electronic distribution of the SR. Contact Linda White, DFA/State Office, at 271-4580 with any questions related to detaching Form 13 to your PC.

Use the current version of Form 808 until stocks are depleted. The revised version will be submitted at the next print order.

CLIENT NOTIFICATION

No special client notification is planned or needed.

TRAINING

No special training is planned or needed.

FORMS POSTING INSTRUCTIONS

DISPOSITION

This SR may be destroyed or deleted after its contents have been noted and the revised manual topics released by this SR have been posted to the On-line manuals.

DISTRIBUTION

This SR will be distributed according to the electronic distribution list for Division of Family Assistance policy releases. This SR, and revised On-Line Manuals, will be available for agency staff in the On-Line Manual Library, and for public access on the Internet, at http://www.dhhs.nh.gov/DHHS/DFA/LIBRARY, effective January 30, 2006.

The paper SR, and printed pages with posting instructions, will be distributed under separate cover to all hard copy holders of the Adult Assistance, Family Assistance, Food Stamp, and Forms Manuals.

DFA/JBV:s