SR 02-37 Dated 12/02

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR releases Spanish language versions of several Division of Family Assistance forms, and also releases the Bosnian Form 800(Bo), Application. These forms are being released to enable New Hampshire’s Spanish and Bosnian-speaking populations to gain better understanding of and access to the Department’s programs and services.

The newly released forms are:

·   Form 77a(Sp), New Hampshire Employment Program and Family Assistance Program;

·   Form 243(Sp), Maybe There is Help;

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

·   Form 754C(Sp), Request For TANF Family/Violence Option;

·   Form 757(Sp), How Your Benefits Will Change When You Go to Work;

·   Form 800(Bo), Application;

·   Form 800(Sp), Application;

·   Form 800HPT(Sp), Application for Assistance; and

·   Form 811S(Sp), Eligibility Interview Summary Signature Page.

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. The Bosnian-speaking population has also increased in New Hampshire, and Application Form 800 has been translated into Bosnian as a result. Additional Spanish and Bosnian language versions of other DFA and Departmental forms will follow and will be released by SR under separate cover.

POLICY

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

District Offices should be aware that completion of Form 800(Bo), Form 800(Sp), or Form 800HPT(Sp) does not relieve the client of the interactive interview requirement. The client may have a Spanish or Bosnian language interpreter present during the interview if necessary.

Whenever possible, the Spanish and Bosnian language versions have been formatted in the same manner as the English language versions. The SR # and date of the Spanish and Bosnian versions match the SR # and date of the most current English version. Each time an English language version changes, the Spanish and Bosnian language versions 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. The suffix "(Bo)" immediately after the form number identifies the form as a Bosnian language version.

IMPLEMENTATION

It is anticipated that the newly released forms will be available in December. Once these forms are received, District Offices and NHEP Teams must begin using the foreign language versions whenever the need arises. Form 800 HPT, Application for Assistance, which is currently being tested in the District Offices, will be finalized and released in a forthcoming SR as a replacement for the current Form 800, Application. At that time, a revised Spanish version and a new Bosnian version of our paper application will also be released.

CLIENT/PROVIDER NOTIFICATION

Clients will be provided with the newly released forms on an as needed basis. Providers that use Form 800 on a routine basis, such as contract child care providers and hospitals will be notified of the availability of Forms 800(Bo) and 800(Sp). Other providers will be notified on an as needed basis.

TRAINING

No training is determined to be necessary to implement use of forms in other languages.

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/ http://www.dhhs.state.nh.us/DHHS/DFA/LIBRARY, effective January 6, 2003.

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

DFA/SJC:s