SR 10-32 Dated 09/10

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR releases the Spanish language versions of:

·   DFA Form 77A(Sp), Financial & Medical Assistance to Needy Families;

·   DFA Form 77C(Sp), NH State Supplement Program;

·   DFA Form 77S(Sp), What Are Liens & Estate Claims;

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

·   DFA Form 770(Sp), Reimbursement Agreement and Acknowledgement;

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

·   DFA Form 800A(Sp), DFA Program and Services Guide.

The Spanish language forms are identified by the suffix "(Sp)" immediately following the form number.

This SR also obsoletes Form 219(Sp), Food Stamp Job Search Program. The English version of this form was obsoleted in DFA SR 10-10, dated July 1, 2010, when the Food Stamp Job Search program was altered, so this Spanish version of the form is no longer needed.

POLICY

The SR number and date of the Spanish versions of the forms released in this SR match the SR number and date of the latest English versions of the forms. The 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

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 www.dhhs.nh.gov/DFA/publications.htm, effective November 1, 2010. Additionally, this SR will be distributed under separate cover to all internal hard copy holders of the Forms Manual.

DFA/JBV:s

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CERTIFICATE OF DESTRUCTION

I certify that all copies of Form 219(Sp), dated June 2001, SR 01-17, 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.