SR 09-31 Dated 01/10

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR releases the relocation of the Berlin Division of Family Assistance District Office #9, from 231 Main Street, Berlin, NH, to 650 Main Street, Berlin, NH.

Additionally, this SR releases revisions to DFA Form 125, Transfer of Client Records, and its associated instructions, and an unrelated change to DFA Form 800, Application for Assistance.

POLICY

Effective January 11, 2010, the new address for the Berlin District Office #9 will be:

NH Department of Health and Human Services

Berlin District Office Division of Family Assistance

650 Main Street

Berlin NH 03570-2431

Phone numbers for the Berlin District Office, including fax lines, remain unchanged.

NEW HEIGHTS SYSTEMS PROCEDURES AND IMPLEMENTATION

Effective December 28, 2009, New HEIGHTS will begin using the new address on all correspondence (NODS, letters, etc.) generated for the Berlin District Office #9.

DESCRIPTION OF REVISIONS MADE TO FORMS

DFA Form 125, Transfer of Client Records

DFA Form 125, Transfer of Client Records, and its associated instructions were originally going to be updated to include the new street address and zip code for the Berlin District Office. However, in researching how this electronic form was used, it was discovered that access to, and the display of, the full address of each District Office in the "From" and "To" fields at the top of the form was unnecessary; only the full District Office name is necessary. As such, DFA Form 125 was instead revised to just designate the full District Office name in both the "From" and "To" sections of the Form. Additionally, all references to "CHAP" workers were removed from the forms, as these workers are no longer available in the District Offices. The instructions were updated accordingly.

Because this form is only available electronically, offices can detach the document from the email releasing the SR and save it into the District Office templates folder on the shared drive. The new version can be used immediately upon receipt.

DFA Form 800, Application for Assistance

After the release of DFA Form 800, Application for Assistance, in SR 09-33, dated 09/09, it was discovered that a minor adjustment was still needed to the "Agency Use Only" box at the top of page 2 in the actual application section of the form. Although there was a separate line collecting case status information for FANF MA and FANF AP, there was not a corresponding separate line collecting this information for Adult MA; there was only a line collecting this information for Adult AP. As such, a separate line to collect this information for the Adult MA group was added to the "Agency Use Only" box. No other changes were made to the form, and there was no need to update the instructions at this time.

Current versions of DFA Form 800 are to be used until the supply is exhausted, at which point the new version will be printed. All versions of DFA Form 800, regardless of the year released, remain valid and must be acted upon whenever received.

IMPLEMENTATION

The Berlin District Office’s new address becomes effective January 11, 2009. Mail will be forwarded from the old address for at least a year, so the current Business Reply envelopes with the old Berlin DO address will continue to be used until the supply is exhausted as a cost-savings measure.

Detach the electronic version of DFA Form 125 released with this SR into the District Office templates folder on the shared drive, and begin using the new version immediately. The new version of DFA Form 800 will be printed when the supply of the current version has been exhausted.

CLIENT NOTIFICATION

A one-time mailing to notify all open cases assigned to the Berlin District office of the new address will occur the week of December 1, 2009. Additionally, a letter to notify clients who are scheduled for a January face-to-face eligibility interview of the new address for their appointment will occur the week of December 7, 2009. Both letters are attached for reference. No other client notification is planned.

TRAINING

No training is planned or needed.

FORMS MANUAL 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.nh.gov/DHHS/DFA/LIBRARY, effective December 7, 2009.

DFA/JBV:s

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CERTIFICATE OF DESTRUCTION

I certify that all e-copies of Form 125, dated 11/07, SR 07-27, have been destroyed.

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.