SR 09-04 Dated 08/09

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR releases:

·   revised Form 243, Maybe There Is Help! The Family Violence Option (FVO); and

·   the obsolescence of the following forms and their associated instructions:

-   Form 475, Coupon Log;

-   Form 794RB, Case Action Review Follow-up Memo;

-   Form 821c, Log of EMS Reports Received Monthly;

-   Form 821d, Log of EMS Reports Received Monthly On Request; and

-   Form 821e, Log of EMS Reports Received Quarterly.

DESCRIPTION OF REVISIONS MADE TO FORMS

Revised Form 243

Form 243, Maybe There Is Help! The Family Violence Option (FVO), was completely revised by the NH Coalition on Domestic and Sexual Violence in coordination with the Division of Family Assistance. Although there were no policy changes, the presentation of the information was streamlined and the language was greatly simplified. Because the policy remains unchanged, the instructions for the form required no revisions so will not be re-released at this time. Additionally, the current supply of the form may be used until it is exhausted. At that time, the new version of Form 243 will be printed.

Obsolescence of Forms

The following forms and their instructions are obsolete effective with the release of this SR:

·   Form 475, Coupon Log;

·   Form 794RB, Case Action Review Follow-up Memo;

·   Form 821c, Log of EMS Reports Received Monthly;

·   Form 821d, Log of EMS Reports Received Monthly On Request; and

·   Form 821e, Log of EMS Reports Received Quarterly.

The forms are associated with the Eligibility Management System (EMS) and were no longer used or needed once the New HEIGHTS automated eligibility system replaced EMS. A Certificate of Destruction has been included at the end of this SR.

IMPLEMENTATION

The former version of Form 243 is to be used until the supply is exhausted. At that time, the new version will be printed and can be used immediately upon receipt. Recycle the listed obsolete forms upon receipt of the SR.

CLIENT NOTIFICATION

No client notification is planned or needed.

TRAINING

No special training is planned or needed.

FORMS MANUAL POSTING INSTRUCTIONS

*Form 821(a) & (b) were obsoleted in SR 04-14, dated April, 2004.

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 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.nh.gov/DHHS/DFA/LIBRARY, effective September 26, 2009. Additionally, this SR will be distributed under separate cover to all hard copy holders of the Family Assistance and Forms Manuals.

DFA/JBV:s

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

CERTIFICATE OF DESTRUCTION

I certify that all copies of the following forms and their instructions, have been destroyed.

·   Form 475, Coupon Log;

·   Form 794RB, Case Action Review Follow-up Memo;

·   Form 821c, Log of EMS Reports Received Monthly;

·   Form 821d, Log of EMS Reports Received Monthly On Request; and

·   Form 821e, Log of EMS Reports Received Quarterly.

District Office Manager of Operations:__________________________________________

District Office _____________________________________________________________ 

Return this certificate to the DFA Policy Unit, 129 Pleasant St, Concord, NH 03301, after the instructions in the SR have been carried out.