SR 02-30 Dated 08/02

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SIGNATURE DATE:	August 22, 2002
FROM:	OFFICE OF THE DIRECTOR Julia Kaplan for Mary Anne Broshek
AT (OFFICE):	Division of Family Assistance
TO:	DFA Supervisors Managers of Administration
SUBJECT:	Release of District Office Procedures and Forms Relating to the Implementation of the Test Version of Revised Form 800HPT, Application for Assistance, and Its Instructions; Release of Procedures Relating to the Screening Pilot for Certain District Offices
EFFECTIVE DATE FOR USE OF THE REVISED FORM 800HPT: EFFECTIVE DATES FOR THE SCREENING PILOT:	August 30, 2002 for all District Offices Berlin: 4/4/02; Portsmouth: 7/29/02; Keene 9/1/02; Manchester: 9/3/02; Nashua: 9/16/02

SUMMARY

This SR releases:

· the test version of revised Form 800HPT, Application for Assistance, and its instructions;

· the District Office procedures relating to the implementation of revised application Form 800HPT; and

· the District Office procedures that will be used in the following offices involved in the Screening Pilot:

- Berlin (began screening pilot on 4/15/02);

- Portsmouth (began screening pilot on 7/29/02);

- Keene (will begin screening pilot on 9/1/02);

- Manchester (will begin screening pilot on 9/3/02); and

- Nashua (will begin screening pilot on 9/16/02).

Old Client Registration Process		New Client Registration Process
· Support staff provided applicants with the "DFA Welcome Sheet." In some District Offices, support staff also provided new applicants with program-specific forms (e.g., child support forms) in addition to the Welcome Sheet..		· The Welcome Sheet will no longer be used. In its place, support staff will provide applicants with revised Form 800HPT, Application for Assistance. No additional forms will be provided at this time. In addition, support staff will no longer ask clients at the receptionist window, "What programs are you applying for?" because program-specific forms will now be provided only after the applicant has returned the completed Form 800HPT.
· Applicants were placed upon the interview rotation list after the Welcome Sheet was returned and a case file was created or located in storage. In those District Offices that provided program-specific forms in addition to the Welcome Sheet, applicants were not placed on the interview rotation list until all the forms had been completed and the case file prepared.		· Applicants will be added to the interview rotation list upon completion of the Form 800HPT. The case file will be created or located in storage after the client’s name has been placed on the interview rotation list.
· If an applicant was unable to stay for an interview or arrived after the District Office’s interview period had ended, the applicant was asked to complete the Welcome Sheet, the Form 800, Application, and/or the paper version of Form 800HP, HEIGHTS Application Form. The completion of the additional form(s) was necessary because the Welcome Sheet was not an official application.		· If an applicant is unable to stay for an interview or has arrived after the interview period has ended, the Form 800HPT is the only form the applicant must complete. Unlike the Welcome Sheet, the Form 800HPT is an actual application; it must be signed, dated, and completed with the client’s name, address, and requested programs of assistance, for validity. Note: Each program of assistance requested on the Form 800HPT must be officially processed in Client Registration (CR). If, for example, a client requests "Cash" on the Form 800HPT and is not eligible for cash, the request must be entered into New HEIGHTS and processed so that a formal Notice of Decision (NOD) will be generated.

BACKGROUND

The Welcome Sheet was originally developed as an informal tool to:

· collect information that would aid District Office staff in determining if the client is currently on assistance or has received assistance in the past;

· identify the program(s) of assistance the individual is requesting so that other program-specific forms could be provided;

· screen for expedited food stamps; and

· shorten the client registration process for applicants.

In analyzing the results of using this tool, the Process Workgroup noted that the Welcome Sheet captured crucial client information but because it was not an application, created an additional form that had to be completed if the client could not be seen the same day they arrived at the District Office. The committee, with contributions from Managers of Administration, District Office Supervisors, and the Director of the Step by Step Career Guidance Program under the Second Start program, simplified this process by combining the Welcome Sheet and the Form 800HP, HEIGHTS Application Form, into new Form 800HPT, Application for Assistance. Because this new form is an application, it will:

· reduce the time requirements made on applicants; and

· improve workflow efficiency in the District Office.

FORM 800HPT, Application for Assistance

Form 800HPT, Application for Assistance, is a 1 page 2-sided form provided by the District Office support staff to all walk-in applicants at the District Offices. The "T" in the current version of the form denotes that it is a test version and has not been finalized.

· Page 1 gathers household information and identifies the programs of assistance requested.

· Page 2 gathers income and resource information and provides space for the applicant’s signature.

Test Form 800HPT replaces the Welcome Sheet, the information-gathering tool previously used by DFA staff as an aid in the client registration process. Effective August 30, 2002, the Welcome Sheet will no longer be used in any District Office.

Although much of the text found on the Welcome Sheet was incorporated into Form 800HPT, unlike the Welcome Sheet the new form is an actual application modeled after the 800H, HEIGHTS Application Form, which is electronically produced at the conclusion of Client Registration (CR) but is also provided in a paper form for use during power outages.

Because the 800HPT is an application:

· each program of assistance requested on the Form 800HPT must be officially processed in Client Registration (CR). If, for example, a client requests "Cash" and is not eligible for cash, all information must be entered into New HEIGHTS and processed so that a NOD will be generated; and

· it is no longer necessary to print out the 800H at the conclusion of CR as the 800HPT replaces the 800H as the client’s official request for assistance. However, because the paper 800HPT will not contain the CR Request for Assistance (RFA) number that was previously generated automatically on the 800H when it was printed during CR, the staff person conducting CR will need to manually note this number on the Form 800HPT for future reference.

The final version of the Form 800HPT will be released under separate cover after a review in two months. When the form has been finalized, it will also be translated into Spanish and Bosnian and released under separate cover. Both the Form 800HPT and its instructions are attached to this SR for reference.

USE OF THE FORM 800HPT IN THE SIMPLIFIED REAPPLICATION PROCESS

The paper version of the HEIGHTS Application Form, Form 800HP released by SR 98-51, dated 12/98, is also used in the simplified reapplication process for applicants or recipients of all categories of financial and medical assistance who failed to provide required verification at application or redetermination (see SR 02-07, dated 2/02). There have been no changes to this policy and use of the Form 800HP for this process is still valid. However, upon receipt of the revised 800HPT, begin using this test application form instead of the Form 800HP for all clients who meet the criteria for the simplified reapplication process.

DISTRICT OFFICE PROCEDURES

The following table describes the procedures to be followed during the testing of new Form 800HPT by District Offices that are not involved in the Screening Pilot.

DO Procedures for Using the Form 800HPT

(for DOs NOT involved in the screening pilot)

Support Staff Responsibilities

· Greet the client and provide the individual with new Form 800HPT, Application for Assistance. Do not ask, "What programs are you applying for?" Do not provide any other program-specific forms. Alert the client that both sides of Form 800HPT must be completed.

· When the client returns the completed Form 800HPT, review the application and ensure that the application has been signed and all questions are answered completely. Offer assistance in completing the form, if necessary. Provide the individual with program-specific forms as needed.

· Complete the "Agency Use Only" sections of the Form 800HPT. The "Agency Use Only" box on page 2 refers to the case head, but look up all individuals in the case. Print screens from the "Individual Information" tab under the "Inquiry" folder for individuals open in another case, such as a child open in a relative’s case in another District Office, and attach the printouts to the Form 800HPT.

· Place the client on the interview rotation list and notify the Family Services Specialist (FSS).

· Create a case file for the client or retrieve the client’s file from storage. The ideal situation is to have the case file prepared prior to the FSS’s interview with the applicant. To avoid delays in having the client seen for an interview, however, this step is not essential. If staff are not able to prepare the case file prior to the FSS calling the applicant in for an interview, provide the FSS with the completed Form 800HPT for the interview and continue preparing the file so that it will be complete by the end of the interview.

· If the client cannot be seen for an interview that day, follow District Office procedures and review for expedited food stamps.

- Provide the client with Form 800AN, Applicant Notice, requesting they return for an interview within 30 days with the listed proofs.

- Explain that the application will be denied if the client does not return for the interview within 30 days.

- Do Client Registration (CR) according to District Office procedures. Do not print out the Form 800H at the conclusion of CR as the completed and signed Form 800HPT is the client’s official application for assistance.

- Copy the Client Registration RFA number onto page 2 of the Form 800HPT, near the "Agency Use Only" section at the bottom of the page for future reference.

Family Services Specialist (FSS) Responsibilities

· If the client is able to stay for the interview, review the Form 800HPT with the client and enter all information into New HEIGHTS. All requested programs of assistance, even if the individual is not eligible for them, must be entered into the system so that a formal NOD can be generated acknowledging the request and providing an eligibility determination.

· Sign in the space indicated on the back of the form.

· At the conclusion of CR, do not print out the Form 800H as the completed and signed Form 800HPT is the client’s official application for assistance. However copy the Client Registration RFA number onto page 2 of the Form 800HPT, near the "Agency Use Only" section at the bottom of the page for future reference.

The following table describes the procedures to be followed by the District Offices involved in the Screening Pilot.

Special Procedures for District Offices Involved in the Screening Pilot

(Berlin, Manchester, Nashua, Keene, and Portsmouth)

Support Staff Responsibilities

· When the client returns the completed Form 800HPT, review the application and ensure that the application has been signed and all questions answered completely.

· Assess whether the individual will be screened. Applicants will be screened unless the individual:

- is adding a program (refer to "Agency Use Only" section on page 2 of the Form 800HPT);

- has had their case closed within the past 30 days for failure to provide verification (refer to "Agency Use Only" section on page 2 of the Form 800HPT);

- is applying for Nursing Home, HCBC, or NH Healthy Kids; or

- is potentially eligible for MEAD (refer to #7 under "Potential Eligibility Questionnaire" on page 1 of the Form 800HPT).

· If the client will be screened, create a case file for the client or retrieve the client’s file from storage, place the client on the interview rotation list, and notify the Family Services Specialist next in rotation.

· If the client will not be screened due to applying for Nursing Home, HCBC, or MEAD, assign the application to the appropriate FSS. If the client will not be screened due to applying only for NH Healthy Kids, notify the client that the FSS will be contacting them shortly to obtain

the additional information necessary to determine eligibility. Prepare the case file according to District Office Procedures.

· If the client is unable to stay for the screening or has arrived after screening hours has ended, review the Form 800HPT and ensure that the application has been signed and all questions are answered completely. Follow District Office procedures and review for expedited food stamps. Provide the client with Form 800AN, Applicant Notice, requesting they return for an interview within 30 days with the listed proofs. Explain that the application will be denied if the client does not return for the interview within 30 days. Do Client Registration (CR) according to District Office procedures. Do not print out the Form 800H at the conclusion of CR as the completed and signed Form 800HPT is the client’s official application for assistance. However copy the Client Registration RFA number onto page 2 of the Form 800HPT, near the "Agency Use Only" section at the bottom of the page for future reference.

Family Services Specialist (FSS) Screening Responsibilities

· Determine if the applicant meets the "hardship" criteria. A full interview will be conducted, rather than the screening process, if the applicant:

- has a transportation issue;

- lives too far away from the office;

- has a conflict with work hours;

- is disabled; or

- meets the expedited food stamp criteria.

· If the applicant does not meet one of the hardship criteria listed above, begin the screening process.

· If the applicant meets one of the hardship criteria, conduct the full application interview.

Screening Procedures

Step 1: Review the Form 800HPT with the client and determine if the client meets gross eligibility criteria.

Client Does Not Meet Gross Eligibility Criteria

Client Meets Gross Eligibility Criteria

· Deny the application in Client Registration (CR) by selecting the most appropriate reason from the CR denial drop-down menu.

· If the choices offered in the CR denial drop-down menu do not clearly indicate the reason for denial, additionally go to "Daily Notices" in New HEIGHTS and enter free form text clearly indicating the reason for the denial in the "Explanation" section of the New HEIGHTS-generated Client Registration Denial Letter (CR-4).

· Provide the applicant with the appropriate program-specific forms for the programs of assistance requested (e.g., child support forms).

· Provide the client with Form 800AN, Applicant Notice, requesting they return for an interview within 30 days with the listed proofs. Explain that the application will be denied if the client does not return for the interview within 30 days.

· Explain the benefits of returning for an interview within 10 days with all required verifications:

- eligibility can be determined the same day, resulting in quicker access to benefits;

- eliminates the need to return required verification through the mail; and

· Issue the CR-4.

· Make referrals to other agencies as needed.

· Confirm that the paper case file contains a clear description of the reason the case was denied.

- eliminates the need to call for an update on case status.

· Explain basic program and policy information for all DFA programs and answer the applicant’s questions.

· Make additional referrals as needed.

Step 2: Enter the information from Form 800HPT into Client Registration on New HEIGHTS. Do not print out the Form 800H at the conclusion of CR as the completed and signed Form 800HPT is the client’s official application for assistance. However copy the Client Registration RFA number onto page 2 of the Form 800HPT, near the "Agency Use Only" section at the bottom of the page for future reference. Give Support Staff the case file to be filed in:

· the suspense file, until the client returns for the full interview; or

· closed records if the screened application did not meet the gross eligibility criteria for the requested program of assistance.

Step 3: When the client returns to the office for the interview, retrieve the application with the copy of the Form 800AN from the suspense file and give it to the next Family Services Specialist on the interview rotation list.

Note: Applicants who arrived at the District Office after the regularly scheduled interviewing/screening hours and were given the Form 800AN, Applicant Notice, by the Support Unit, will not be screened by the Family Services Specialist upon their return, but will be interviewed by the next available Family Services Specialist on the interview rotation list.

Screened Applicant Wants to Withdraw Application

If during screening the client decides to withdraw their application and forego the interview process, have the client complete the Form 65, Client Statement, to withdraw the application. The FSS must additionally:

· deny the case in client registration to document the application and eligibility decision; and

· issue a Client Registration Denial Letter (CR-4).

POLICY MANUAL REVISIONS

No manual changes are being released at this time. Manual changes will be released under separate cover following the finalization of the test version of the Form 800HPT.

IMPLEMENTATION

Use of the attached test version of Form 800HPT will begin in all District Offices on August 30, 2002. All District Offices have received an initial supply of the revised versions of the form in preparation for the implementation date. Reorder as needed, using the normal ordering procedures. District Offices additionally involved in the Screening Pilot will implement the pilot according to the following schedule:

· Berlin: April 14, 2002;	· Portsmouth: July 29, 2002;
· Keene: September 1, 2002;	· Manchester: September 3, 2002; and
· Nashua: September 16, 2002.

CLIENT NOTIFICATION

No special notification is necessary. Individuals will be advised of the revised procedures on an individual as needed basis, when requested, or when application for assistance is requested.

TRAINING

No special training is planned for the implementation of test Form 800HPT as the Managers of Administration and the District Office Supervisors have been active participants in the development of this form. However, a review meeting will be scheduled to discuss any areas of concern resulting from the form’s implementation.

The District Offices involved in the Screening Pilot will be trained by Mickie Grimes, Field Operations Supervisor. Any questions about the pilots should be directed to Mickie.

POSTING INSTRUCTIONS

Remove and Destroy

Insert

Forms Manual

Form 800HP, SR 98-51/December 1998

1 sheet

Form 800HP(i), SR 98-51/December 1998

1 sheet

Form 800HPT, SR 02-30/August 2002

1 sheet

Form 800HPT(i), SR 02-30/August 2002

1 sheet

DISPOSITION

This SR may be destroyed or deleted after its contents have been noted and the SR has been posted to the on-line manuals.

DISTRIBUTION

This SR will be distributed according to the electronic distribution list for DFA policy releases and will be available to agency staff in the On-Line Manual Library and to the public on the Internet at http://www.dhhs.state.nh.us/DHHS/DFA/LIBRARY/Manual/A1.htm, effective October 4, 2002. This SR will also be distributed under separate cover to all hard copy holders of the Forms Manual.

DFA/JBV:s

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CERTIFICATE OF DESTRUCTION

I certify that all copies of Form 800HPT dated 12/98, SR 98-51 and the informal document entitled "The Welcome Sheet" have been destroyed.

Office Manager: District Office

Return this certificate to DHHS Stock Control, 6 Hazen Drive, Concord, NH 03301, after the instructions in the SR have been carried out.