SR 02-31 Dated 12/02

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR releases revisions to:

·   Form 754B, Good Cause Claim for Non-Cooperation with Child Support; and

·   Form 754C, Request For TANF Family/Violence Option.

BACKGROUND

In February 2000, revised Form 754B, Good Cause Claim for Non-Cooperation with Child Support, and new Form 754C, Request For TANF Family/Violence Option, were released when the Department of Health and Human Services adopted the family/domestic violence option (FVO), available in the TANF program (see SR 00-08 dated 02/00). Form 754B was revised to reflect the Family Violence Option, while Form 754C was a new form developed by a committee made up of representatives from the Division of Family Assistance, the Division of Child Support Services, the New Hampshire Coalition Against Domestic and Sexual Violence, the Division of Children, Youth and Families, and NH Legal Assistance.

In the fall of 2001, the committee met to evaluate the two forms’ effectiveness. Concerns were expressed about a section in both forms regarding what might occur if a client indicated that child(ren) and/or elderly or handicapped adult household members were or had been at risk of being victims of domestic/family violence.

The statement advised the client that telling their DHHS worker about family/domestic violence of a household member legally obligated the DHHS worker to report that information to the Division of Children, Youth and Families (DCYF) and/or Division of Elderly and Adult Services (DEAS). The committee members believed that the client’s fear of being reported to DCYF or DEAS would prevent the client from disclosing a domestic violence situation, and, as a result, may prevent the client from obtaining information, access, and/or referral to services which might otherwise be available.

Disclosure of domestic violence, in and of itself, does not automatically result in a mandatory report. Disclosure of either child or elder/incapacitated adult abuse does require the Family Services Specialist (FSS) to make a report to either DCYF or DEAS.

Concerns were also raised about the phrasing of text on Form 754C indicating that clients who provided false information would be prosecuted. Committee members believed that the strong language used, which cited RSA 167:17-b and 17-c, could also be a disincentive to claiming the family/domestic violence option.

It is the Department’s intent to provide comprehensive support and services to families affected by family/domestic violence, so both forms were altered.

FORMS REVISIONS

Form 754B, Good Cause Claim for Non-Cooperation with Child Support

The following changes have been made to Form 754B:

·   the text box concerning mandatory reporting for indications that a child or elderly/incapacitated adult household member was or had been at risk of being a victim of family/domestic violence was removed; and

·   the reference to Case Technician in the signature line was changed to Family Services Specialist.

Form 754C, Request for TANF Family/Domestic Violence Option

Changes to Form 754C include the following:

·   the wording regarding required documentation was modified to indicate that the client may provide "any" of the required documentation to substantiate a family/domestic violence claim. Previous wording was unclear and did not reflect the intent of SR 00-08;

·   the text box concerning mandatory reporting for indications that a child or elderly/incapacitated adult household member was or had been at risk of being a victim of family/domestic violence was removed;

·   the statement that individuals providing false information would be prosecuted was modified; and

·   the reference to Case Technician in the signature line was changed to Family Services Specialist.

Form 754C(i), Instructions for Form 754(C), was revised accordingly.

IMPLEMENTATION

State Office will provide District Offices with an initial supply of the revised forms and staff must begin using the revised forms upon receipt. Old versions of the forms must be destroyed or recycled immediately. When your initial supply is depleted, reorder using standard form reordering procedures.

CLIENT NOTIFICATION

No special client notification is planned.

TRAINING

Training will be provided to the field in conjunction with other family/domestic violence training concerning the assessment process or on an as needed basis.

POSTING INSTRUCTIONS

DISPOSITION

This SR may be destroyed or deleted after its contents have been noted, the SR has been posted to the On-line manual, and the revised forms have been distributed to Family Services Specialists and Team Members.

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.state.nh.us/DHHS/DFA/LIBRARY, effective January 6, 2003.

This SR, and printed pages with posting instructions, will be distributed under separate cover to all hard copy holders of the Forms Manual.

DFA/LG:SJC

------------------------------------------------------------------------------------------------------------------

CERTIFICATE OF DESTRUCTION

I certify that all copies of Form 754B and 754C, dated 2/00, SR 00-08, 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.