SR 03-09 Dated 05/03

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

/Á*This SR releases:

·   a month-long pilot that will begin on May 1, 2003 in 5 District Offices; and

·   the procedures that the 5 District Offices involved in the pilot will follow.

The pilot will:

·   implement a new screening process; and

·   test the newly revised Form 800, Application for Assistance, and Form 811, Screening Worksheet.

The following 5 District Offices will implement the new screening process using the newly revised forms:

·   Berlin;

·   Claremont;

·   Manchester;

·   Nashua; and

·   Rochester.

The following chart summarizes the changes released in this SR:

BACKGROUND

SR 02-30, dated August 2002, released the procedures for a previous screening pilot along with test Form 800HPT, Application for Assistance. It was determined that the screening pilot helped to eliminate 26.8% of applicants who were grossly ineligible for assistance. As a result:

·   the client did not have to participate in a full 1 to 1½ hour interview to find out that he/she was not eligible for assistance;

·   the Family Services Specialist did not have to conduct a full interview to discover that the applicant was not eligible for assistance; and

·   the Family Services Specialist could better determine federal, state, or local programs for which the client could potentially be eligible and refer the client to those programs.

During meetings with the Process Committee, Mangers of Administration, DFA Supervisors, State Office Representatives, and the Director of DFA, it was determined that because the initial screening process successfully improved customer service, the pilot would be continued a month longer to incorporate:

·   a new screening worksheet to standardize the screening process. This worksheet was developed and used in the Nashua District Office during the pilot released by SR 02-30 and is based upon a worksheet formerly used with the EMS System, the computerized eligibility system in operation prior to New HEIGHTS; and

·   suggested changes to Form 800HPT, the test form released during the original screening pilot. These changes were subsequently added into the revisions made to Form 800 and released by this SR.

The current month-long pilot program for the screening process will allow District Offices of various sizes an opportunity to use the newly revised forms in conjunction with the revised screening procedures so that feedback regarding enhancements to the process can be incorporated as needed, prior to statewide implementation.

POLICY

Beginning May 1, 2003, a month-long screening pilot will be conducted in:

·   Berlin;

·   Claremont;

·   Manchester;

·   Nashua; and

·   Rochester.

The pilot will implement a standardized screening process and test the newly revised Form 800, Application for Assistance, and Form 811, Screening Worksheet. The newly revised forms and the procedures outlined below are to be used only in the 5 District Offices involved in the pilot.

Form 800, Application for Assistance

During the pilot, revised Form 800, dated 7/03, will replace current forms used in the application process and become the official application for requests for assistance.

NOTE: Although the District Offices involved in the pilot will not be using them, Form 800 and Form 800HPT remain valid applications and District Offices must accept completed applications submitted on these forms.

Form 811, Screening Worksheet

The Family Services Specialist will use revised Form 811 in conjunction with newly revised Form 800 during the 10 to 15 minute face-to-face screening that occurs prior to the New HEIGHTS interactive interview. Form 811 provides space for notes and calculations as well as text prompts and check boxes to aid the Family Services Specialist in asking key questions during the screening process to assess eligibility of the client.

Form 811S, Statements of Understanding, and Form 811R, Your Rights and Responsibilities

The Statements of Understanding and Your Rights and Responsibilities are currently generated by New HEIGHTS during the Eligibility Interview Summary (EIS) at the end of the interactive interview, at which time they are reviewed with and signed or initialed by the applicant. Paper versions of the forms (Forms 811S and Form 811R respectively) have been used only as a back up in the event of a New HEIGHTS failure or power outage.

During the pilot, the paper versions of Form 811S and Form 811R will be supplied to every individual at the beginning of the application process, regardless of whether the applicant is visiting the District Office in person or must be mailed an application. However, provision of the paper versions of the forms to the client are for informational purposes only; providing these forms prior to the screening will allow the applicant an opportunity to review his/her rights and responsibilities, as well as preview the statements of understanding. FSS will continue to review the Statements of Understanding and Your Rights and Responsibilities when generated by EIS to ensure client comprehension and to obtain the necessary signatures for the case file.

FORMS REVISIONS

Form 800 is modeled after Form 800HPT, SR 02-30/August, 2002, with the addition of a coversheet that contains a brief description of the programs administered by DFA, and was revised to incorporate:

·   suggestions from the Office of Civil Rights;

·   information on citizenship and the use of Social Security Numbers;

·   highlighted areas to help determine expedited Food Stamps;

·   a section for ethnic and racial data collection; and

·   simplified readability for the client.

Form 811 is modeled after Form 63, Change of Information, SR 84-28/April 1984, and Form 811, Eligibility Determination Worksheet, SR 97-08/March 1997, and was revised to incorporate:

·   ample space for notes and calculations; and

·   questions and check off boxes designed to prompt the Family Services Specialist to cover certain subjects during the screening.

The paper version of the Form 811S, Statements of Understanding, which will be provided to applicants for informational purposes only, has been slightly revised to remove the signature block. This change was made both to reflect the informational nature of the form and to ensure that clients continue to initial and sign their name as indicated on the Statements of Understanding generated during EIS. The paper version of 811R, Your Rights and Responsibilities, remains unchanged. Instructions for both forms have been revised to indicate the new procedure of supplying these forms at the beginning of the application process.

SCREENING PROCEDURES (For the 5 District Offices Involved in the Pilot Only)

Screening for the 5 District Offices involved in the pilot consists of a 10 to 15 minute face-to-face discussion between the client and the Family Services Specialist regarding the information provided on Form 800. New HEIGHTS is not used during the process. New information collected during the discussion is handwritten in the appropriate places on revised Form 811.

Support Staff

During the pilot, all individuals who request assistance during normal walk-in hours will be screened. Support staff will:

·   Greet the client and provide the individual with the new Form 800, Application for Assistance, dated 07/03. Do not provide any other program-specific forms.

·   When the client returns the completed Form 800, review the application to ensure that the application has been signed and all questions answered completely. Lift up the coversheet and date stamp the application.

NOTE: All applicants must provide their name, address, signature and type(s) of assistance requested for the application to be valid.

·   Provide the client with Form 811S, Statements of Understanding, and Form 811R, Your Rights and Responsibilities, as well as appropriate forms pertinent to the type of assistance requested.

·   Complete the "Agency Use Only" sections of the Form 800, looking 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 800.

·   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 is unable to stay for an interview or has arrived after walk-in hours have ended:

-   review the Form 800 and ensure that the application has been signed and all questions are answered completely;

-   provide the client with Form 811S, Statements of Understanding, and Form 811R, Your Rights and Responsibilities.

-   review for expedited food stamps. If found ineligible for expedited Food Stamps, have the DFA Supervisor review the application a second time;

-   fill out the "Agency Use Only" section on the back of the coversheet of the Form 800, acknowledging DFA’s receipt of the application and when it was filed. Tear the coversheet off and give it to the client;

-   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; and

-   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 800 is the client’s official application for assistance. However enter the Client Registration RFA number in the "Agency Use Only" section at the bottom of the last page of the application for future reference.

Expedited Food Stamps

After District Office walk-in hours have ended, support staff must screen all walk-in applicants for expedited Food Stamp eligibility. If one of the following circumstances applies on the date of application, the individual must be seen by a Family Services Specialist:

·   Gross monthly income is less than $150 and the countable liquid resources are $100 or less; or

·   Rent/mortgage and utility expenses are more than the applicant’s combined monthly gross income and liquid resources.

-   When determining shelter and utility costs, use the appropriate SUA (property taxes and home insurance are not considered).

-   When determining monthly income amounts, the weekly amount is multiplied by 4.33; the bi-weekly amount is multiplied by 2.17.

Family Services Specialist

During normal walk-in hours, Family Services Specialists will meet with all applicants for a 10 to 15 minute screening using the Form 811, Screening Worksheet, in conjunction with revised Form 800. New HEIGHTS will not be used during this face-to-face discussion with the client.

·   During the 10 to 15 minute screening, the FSS will determine if the applicant is:

-   not eligible for assistance;

-   potentially eligible for assistance; or

-   potentially eligible for some, but not all assistance requested.

·   At supervisor discretion, the FSS may begin Client Registration (CR) at his/her desk prior to the screening.

NOTE: If it is not clear who CR should be under, do not begin CR before the screening. All CR begun by the FSS must be completed by the FSS.

·   During the 10 to 15 minute face-to-face screening process with the client, use the spaces provided on Form 811 to document any information that may help clarify the information that is on Form 800. Use the prompts and/or check boxes at the bottom of the sections to help identify areas that need to be addressed during the screening. Do not enter data into New HEIGHTS while meeting with the applicant during the initial screening.

·   Regardless of the eligibility determination during the screening process, complete the "Agency Use Only" section on the back of the coversheet of the Form 800, acknowledging DFA’s receipt of the application and when it was filed. Tear the coversheet off and provide to the client.

Applicant is Determined to be NOT Eligible for Assistance During the Screening

If the client is found ineligible for all programs of assistance requested after the 10-15 minute face-to-face screening, then the FSS will proceed with the following steps:

·   Discuss the reason(s) why the individual is ineligible for assistance. Refer the individual to a Community, State, or Federal Agency that may be able to assist them.

·   Give the individual an opportunity to withdraw the application. Notify the client that if they withdraw, they may reapply at any time and advise the client that by withdrawing the application, the individual forfeits the right to an Administrative Appeal.

·   If the individual does not withdraw the application, the application must be denied in Client Registration.

·   Begin Client Registration using the shortened application.

·   At the "Conclude Interview" screen, RFA Status Information, change Status to "Denied" and choose the most appropriate denial code. Statistics will be gathered by the system on the number and type of denials completed in CR each month. Although additional codes will be added in the future, the current denial codes are:

-   Income Exceeds the Gross Income Limit;

-   No Eligible Member in AG;

-   Resources Exceed Limit;

-   Client Walked Out;

-   Interview Denial; and

-   Client Withdrew.

·   Add case comments specifying why the applicant is not eligible.

·   Print and close.

·   Complete Form 811, Screening Worksheet, as needed, and file in the client’s record.

·   Give the case file to the support staff to be filed in the closed records.

NOTE: All Client Registration denials must be completed prior to seeing the next applicant.

Applicant is Determined to be POTENTIALLY Eligible for Assistance During Screening

If it is determined during the screening that the client is not eligible for one or some of the programs requested, then the FSS will proceed with the following steps:

·   Let the client know which assistance program(s) will be denied and the reasons for denial.

·   Give the applicant the opportunity to partially withdraw their request for assistance for those programs for which they are not eligible, again advising them about forfeiting the right to an Administrative Appeal, and that they may reapply for those programs at any time.

·   At the conclusion of the screening, complete the shortened Client Registration and proceed with the interview in Application Entry.

·   Because Form 800 is an official application, every program of assistance requested by the client must be acted upon. If the applicant is eligible for some but not all programs, the FSS can do a partial withdrawal/denial of a program(s) requested in the Program of Assistance screen of New HEIGHTS. The following steps need to be completed for each program in which the client has been found to be ineligible. On the Program of Assistance, Request Assistance Summary screen:

-   choose the Request Assistance Details tab for the program which is being withdrawn or denied;

-   select "yes" for all programs checked off on the Form 800;

-   for denied programs, select "no" for "Individuals to be Included." Select "no" (request) and select an appropriate reason for each individual in the case;

-   continue this process for all denied or withdrawn programs; and

-   finish the interview and run SFU/EDBC. This will deny the programs for which the client is found ineligible, pend the programs for which the client is found potentially eligible, and generate a NOD once the case is confirmed.

Completion of Interview

At the completion of the interview, the FSS will:

·   Generate the Eligibility Interview Summary (EIS) from New HEIGHTS.

·   Review all EIS information and have the client initial and sign in the appropriate spaces.

NOTE: During the review of the EIS information, ensure that the client signs and initials where indicated, attesting to their comprehension of Your Rights and Responsibilities, and the Statements of Understanding.

·   Sign and date your name in the spaces provided.

·   Provide the applicant with an appropriate information packet. The contents of the packet will be based on the programs of assistance for which the client is found eligible. Contents of the packet will include:

-   the FSS and District Office business cards;

-   Form 215, Reporting Requirements Handout;

-   appropriate forms to be filled out by the client;

-   resources list (a list of other agencies that may be able to assist the client);

-   return envelope(s);

-   Form 77n, What’s Next;

-   appropriate program pamphlets;

-   rental and wage verification forms;

-   Your Rights and Responsibilities from the EIS printout;

-   referrals such as NHEP and Food Stamp (NOTE: Combine the NHEP white packet with the information packet so the client receives only 1 packet); and

-   the verification checklist.

·   complete Form 811, Screening Worksheet, as needed, and file in the client’s record.

POLICY MANUAL REVISIONS

No manual page changes are being released at this time. Manual changes will be released under separate cover following the finalization of Form 800 and Form 811.

IMPLEMENTATION

Beginning May 1, 2003, and for the duration of the pilot, the 5 District Offices involved in the pilot must use the newly revised Form 800, Application for Assistance, for the official DFA application, and Form 811, Screening Worksheet, during the screening process. The 5 District Offices must provide Form 800 to all walk-in clients, mail to all clients requesting an application, and use for all add a program requests as well as for the simplified reapplication process. However, the District Offices involved with the screening pilot must continue to accept incoming applications that have been completed using Form 800, SR 98-51/November 1998 and Form 800HPT, SR 02-30/August, 2000. Do not destroy current supplies of these forms, simply do not hand them out during the pilot.

The 5 District Offices received an initial supply of the revised versions of the forms in preparation for the May 1, 2003 implementation date.

CLIENT NOTIFICATION

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

TRAINING

The District Offices involved in the Screening pilot will be trained by Mickie Grimes, Field Operations Supervisor and Leader of the Process Workgroup, which developed the concept. No additional training is planned as the Managers of Administration and the District Office Supervisors have been active participants in the development of the forms and process. However, a review meeting will be scheduled to discuss any areas of concern resulting from the forms’ implementation, in preparation for statewide implementation. Questions and concerns about the pilots should be directed to Mickie.

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, effective June 1, 2003.

DFA/DMS:s