SR 10-38 Dated 11/10

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR releases:

·   new DFA Form 77W, Calling About Your Application, and its associated instructions; and

·   the obsoletion of DFA Form 800M, Important Information About Your Benefits, and its associated instructions.

POLICY

DFA Form 77W, Calling About Your Application

New DFA Form 77W, Calling About Your Application, was created to inform all applicants that:

·   it takes 30 to 90 days to process a new application when all required proof has been provided timely; and

·   because there will be nothing known on the status of the individual’s application during the initial 30-days of processing, staff will not be returning calls about the status of the individual’s application during that first 30-day period.

Provide DFA Form 77W to every new applicant.

DFA Form 800M, Important Information About Your Benefits

DFA Form 800M, Important Information About Your Benefits, and its associated instructions are obsolete with the release of this SR. DFA Form 800M was created as a result of the Jones v. Merrill court case. The consent decree stipulated that clients be notified about how to continue to receive Food Stamp benefits without interruption when recertification comes due. Because the New HEIGHTS-generated CS0001, Interview Appointment Notice, and CS0005, Mail-In Application for Redetermination/Recertification, as well as DFA Form 800R, Application for Continued Eligibility for Financial, Medical, and Food Stamp Benefits, all contain text notifying clients how to continue to receive benefits timely and how to prevent delays in the recertification process, the paper Form 800M is no longer used or needed. A Certificate of Destruction has been included with this SR.

DESCRIPTION OF NEW DFA FORM 77W

DFA Form 77W, Calling About Your Application, is a 1/3-page, single panel, single-sided leaflet. The form is used to notify every new applicant for DFA assistance that:

·   it takes 30 to 90 days to process a new application when all required proof has been provided timely; and

·   because there will be nothing known on the status of the individual’s application during the initial 30-days of processing, staff will not be returning calls about the status of the individual’s application during that first 30-day period.

Because DFA Form 77W is an informational pamphlet, it is not retained in the case record. Instructions for this new form were created accordingly.

DISTRICT OFFICE PROCEDURES AND IMPLEMENTATION

Current application processing timelines remain unchanged, pursuant to:

·   Family Assistance Manual PART 117, APPLICATION PROCESSING TIME FRAMES;

·   Food Stamp Manual PART 117, APPLICATION PROCESSING TIME FRAMES; and

·   Adult Assistance Manual PART 116, APPLICATION PROCESSING TIME FRAMES.

However, Family Services Specialists and Client Services staff will not have to return calls during the initial 30-days of processing the application when the question from the individual is merely about the status of their application. All other types of calls must be returned according to current operating procedures.

POLICY MANUAL REVISIONS

Revised Adult Assistance Manual Topics

PART 116  APPLICATION PROCESSING TIME FRAMES

IMPLEMENTATION

All District Offices have been supplied with an initial stock of new DFA Form 77W and can begin using the new form upon receipt. Reorder this form from DHHS Logistics at your office’s next quarterly forms order requisition when supplies run low.

CLIENT NOTIFICATION

No special client notification is planned or needed.

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 and the revised manual topics released by this SR have 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 January 31, 2011. Additionally, this SR, and printed pages with posting instructions, will be distributed under separate cover to all internal hard copy holders of the Adult Assistance and Forms Manuals.

DFA/JBV:s

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CERTIFICATE OF DESTRUCTION

I certify that all copies of Form 800M, dated 1/94, SR 94-3, 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.