SR 10-33 Dated 09/10

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR releases revised DFA Form 800W, Website Forms, and its associated instructions.

POLICY

Revisions to DFA Form 800W, Website Forms, and its associated instructions, were precipitated by the unveiling of the revised Department of Health and Human Services (DHHS) website that occurred on September 9, 2010. Web addresses for all the DFA "mini-sites" had been altered during the DHHS website transformation. Although every DFA form containing a web address is impacted by the changes in the DFA mini-site web addresses, only DFA Form 800W is being re-released at this time due to the basic purpose of the form.

As released in SR 10-19, dated June 2010, one of the purposes of Form 800W is to provide the applicant with a paper copy of:

§   the website address that the applicant needs to access;

§   the list of forms that all applicants must review on the website; and

§   the list of program-specific forms associated with the assistance the applicant is requesting.

Because Form 800W now contains the wrong DFA web address and the correct web page is difficult to locate from the redesigned DHHS website, DFA Form 800W requires an immediate revision.

The June 2010 version of DFA Form 800W is no longer valid. Recycle all DFA Form 800W stocked in the District Office and begin using the new version of the form immediately upon receipt.

DESCRIPTION OF REVISIONS MADE TO DFA FORM 800W

DFA Form 800W, Website Forms, was revised to replace the current web address provided on the form with the following address: www.dhhs.nh.gov/DFA/apply.htm. DFA Form 800W was additionally modified to better align the way information is provided on the paper form with the way information is now presented on the revised DHHS website.

Additionally, DFA Form 800W will no longer be printed on 2-part no-carbon-required (NCR) paper. Instead, Family Services Specialists should do the following when using the form:

·   If the applicant signs and dates DFA Form 800W and the office is able to scan documents: Scan DFA Form 800W into New HEIGHTS and then give the original DFA Form 800W to the applicant for the applicant’s records.

·   If the applicant signs and dates DFA Form 800W and the office is not able to scan documents: Make a copy of DFA Form 800W for the case record and give the original to the applicant.

·   If the applicant refuses to sign and date DFA Form 800W: Give the applicant the paper copies of the forms listed on DFA Form 800W that are pertinent to the programs of assistance the applicant is requesting. (This last policy remains unchanged from SR 10-19, dated June 2010)

The instructions for the form were updated accordingly.

A small supply of the revised version of DFA Form 800W containing the new web address has been supplied to every District Office as of the release of this SR. District Offices must recycle the June 2010 versions of the form and begin using the new version immediately. When the initial supply is exhausted, District Offices may reorder more through the usual forms’ reordering process. A Certificate of Destruction has been included with this SR.

IMPLEMENTATION

Begin using the new versions of DFA Form 800W, Website Forms, upon receipt of the initial supply from State Office. Discontinue use of the version of DFA Form 800W dated June 2010 immediately.

CLIENT NOTIFICATION

No special client notification is planned.

TRAINING

No special training is planned.

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. 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 800W, dated 6/10, SR 10-19, 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.