SR 10-34 Dated 09/10

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

DFA SIGNATURE DATE:	September 27, 2010
FROM:	OFFICE OF THE DIRECTOR, DFA JSO for Terry R. Smith
AT (OFFICE):	Division of Family Assistance
TO:	DFA Supervisors
SUBJECT:	Release of New Bosnian Language Versions of DFA Forms 757(Bo), How Your Benefits Will Change When You Go To Work, and DFA Form 770(Bo), Reimbursement Agreement and Acknowledgement
EFFECTIVE DATE:	September 30, 2010

SUMMARY

This SR releases the Bosnian language versions of:

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

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

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

POLICY

The SR number and date of the Bosnian versions of the forms released in this SR match the SR number and date of the latest English versions of the forms. The Bosnian 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 both 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, Conway, Littleton, and Salem District Offices.

Central Healthy Kids District Office and each NHEP Team Statewide will also receive 10 copies of DFA Form 757(Bo).

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 757(Bo), How Your Benefits Will Change When You Go To Work,

DFA SR 09-17/June, 2009

1 sheet (back-to-back)

Form 770(Bo), Reimbursement Agreement and Acknowledgement, SR 06-06/April, 2006

*most text was still from SR 03-06, dated 04/03, however

2 sheets, 3-Part NCR

DFA Form 770(Bo), Reimbursement Agreement and Acknowledgement,

DFA SR 06-06/April, 2006

1 sheet

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