SR 10-30 Dated 07/10 |
STATE OF NEW HAMPSHIRE
INTER-DEPARTMENT COMMUNICATION
DFA SIGNATURE DATE: |
July 16, 2010 |
FROM: |
OFFICE OF THE DIRECTOR, DFA Terry R. Smith |
AT (OFFICE): |
Division of Family Assistance |
TO: |
DFA Supervisors
|
SUBJECT: |
Release of New Bosnian Language Versions of DFA Forms 77A(Bo), Financial and Medical Assistance to Needy Families, DFA Form 77C(Bo), NH State Supplement Program; DFA Form 77S(Bo), What Are Liens and Estate Claims, DFA Form 800(Bo), Application for Assistance, and Release of New Spanish Language Versions of DFA Forms 260(Sp), Financial Assistance to Needy Families (FANF) Fact Sheet, and DFA Form 811R(Sp), Your Rights and Responsibilities |
EFFECTIVE DATE: |
July 23, 2010 |
SUMMARY
This SR releases the Bosnian and Spanish language versions of:
· DFA Form 77A(Bo), Financial and Medical Assistance to Needy Families;
· DFA Form 77C(Bo), NH State Supplement Program;
· DFA Form 77S(Bo), What Are Liens and Estate Claims;
· DFA Form 260(Sp), Financial Assistance to Needy Families (FANF) Fact Sheet;
· DFA Form 800(Bo), Application for Assistance; and
· DFA Form 811R(Sp), Your Rights and Responsibilities.
The Bosnian language forms are identified by the suffix "(Bo)" immediately following the form number and the Spanish language forms are identified by the suffix "(Sp)’ immediately following the form number.
POLICY
The SR number and date of the Bosnian and Spanish versions of the forms released in this SR match the SR number and date of the latest English versions of the forms. The Bosnian and Spanish language versions of the forms released in this SR are used in the same manner as the English versions; therefore, no form instructions are being re-released.
IMPLEMENTATION
An initial supply of each of the forms released in this SR has been sent to each office as follows:
§ 25 of each individual form to the Claremont, Concord, Keene, Laconia, Manchester, Southern, Seacoast, and Rochester District Offices; and
§ 10 copies of each individual form to the Berlin, Central Healthy Kids, Conway, Littleton, and Salem District Offices.
Once copies of the forms released by this SR are received, offices may begin using the foreign language versions whenever the need arises. Reorder by contacting the Supervisor of the DFA Policy Development Unit and specifying the amount needed.
For Department employees, the forms released in this SR are also all available electronically on the Family Services database in Lotus Notes.
CLIENT NOTIFICATION
Clients will be provided with the newly released forms on an as needed basis.
TRAINING
No special training is planned or needed.
FORMS MANUAL POSTING INSTRUCTIONS
Remove and Destroy |
Insert
|
Forms Manual
|
|
None |
DFA Form 77A(Bo), Financial and Medical Assistance to Needy Families, SR 08-04/April, 2008, Rev. 4/10 1 sheet |
None |
DFA Form 77C(Bo), NH State Supplement Program, SR 08-06/October, 2008, Rev. 4/10 1 sheet |
None |
DFA Form 77S(Bo), What Are Liens and Estate Claims, SR 06-06/April, 2006, Rev. 4/10 1 sheet |
DFA Form 260(Sp), Financial Assistance to Needy Families (FANF) Fact Sheet, SR 08-04/April, 2008 1 sheet (back-to-back) |
DFA Form 260(Sp), Financial Assistance to Needy Families (FANF) Fact Sheet, SR 09-11/October, 2009 1 sheet (single-sided) |
Form 800(Bo), Application, SR 98-51/November, 1998 7 sheets (back-to-back) |
DFA Form 800(Bo), Application for Assistance, SR 10-11/January, 2010 4 sheets (back to back) |
Form 811R(Sp), Your Rights and Responsibilities, SR 08-04/April, 2008 1 sheet (back-to-back) |
DFA Form 811R(Sp), Your Rights and Responsibilities, SR 08-17/February, 2006 1 sheet (back-to-back) |
DISPOSITION
This SR may be destroyed or deleted after its contents have been noted, the attached forms posted to the paper Forms Manual, 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 August 2, 2010. Additionally, this SR will be distributed under separate cover to all internal hard copy holders of the Forms Manual.
DFA/JBV:s