SR 02-34 Dated 09/02

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR releases Spanish language versions of several Division of Family Assistance forms. These forms are being released to enable New Hampshire’s Spanish-speaking population to gain better understanding of and access to the Department’s programs and services.

The newly released forms are:

·   Form 221(Sp), The New Hampshire Employment Program;

·   Form 242(Sp), The 60 Month Lifetime Limit on TANF Financial Assistance;

·   Form 778(Sp), Authorized Representative Declaration;

·   Form 781(Sp), Good Cause Claim/FVO Decision;

·   Form 800P(Sp), Application for NH Healthy Kids Medical Insurance or Medical Coverage for Pregnant Women;

·   Form 800PR(Sp), Review For Continued Eligibility For NH Healthy Kids Medical Insurance and Medical Coverage for Pregnant Women; and

·   Form EFT-R(Sp), Information Required to Process Electronic Funds.

BACKGROUND

Title VI of the Civil Rights Act of 1964 prohibits agencies in receipt of federal financial assistance from denying persons with limited English proficiency access to programs on the basis of national origin. As a result of Presidential Executive Order 13166 dated August 11, 2000, the U.S. Department of Health and Human Services issued written policy guidance on August 30, 2000, for health and human services providers to ensure language assistance for individuals with limited English proficiency. In response to the state’s increasing Spanish-speaking population, several DFA forms have been translated into Spanish language versions. Additional Spanish language versions of other DFA and Departmental forms will follow and will be released by SR under separate cover.

POLICY

Generally speaking, the Spanish language versions of DFA forms will be used in the same manner as the English versions. Therefore, no forms instructions are being released for the Spanish language forms.

Whenever possible, the Spanish language versions have been formatted in the same manner as the English language versions. The SR # and date of the Spanish version match the SR # and date of the most current English version. Each time an English language version changes, the Spanish language version will be changed accordingly and released by SR with the revised English version. Spanish language forms are identified by the suffix "(Sp)" immediately after the form number.

IMPLEMENTATION

It is anticipated that the Spanish language forms will be available in mid-October. Once these forms are received, District Offices and NHEP Teams must begin using the Spanish language versions when the need arises.

CLIENT/PROVIDER NOTIFICATION

Clients will be provided with the Spanish language versions of various forms on an as needed basis. NH Healthy Kids Corporation will furnish Community outreach agencies in the southern tier of the state with an initial supply of Form 800P(Sp), and notify other community agencies of the availability of the Spanish language versions.

TRAINING

No training is planned.

POSTING INSTRUCTIONS

DISPOSITION

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

DISTRIBUTION

This SR will be distributed according to the electronic distribution list for Division of Family Assistance policy releases. This SR 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/Manual/A1.htm, effective September 1, 2002.

This SR will be distributed under separate cover to all hard copy holders of the Forms Manual.

DFA/SJC:s