SR 11-13 Dated 11/11

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR releases new DFA Form 800R[EFS], Extended Food Stamp (EFS) Application for Continued Eligibility for Food Stamp Benefits ONLY, and its associated instructions. This two-page, two-sided printed form will be used only with EFS recipients who are approaching the end of their 5-month EFS eligibility period.

This SR additionally releases related revisions to DFA Form 800R, Application for Continued Eligibility for Financial, Medical, Child Care, and Food Stamp Benefits, and its associated instructions. DFA Form 800R and its instructions were updated to incorporate enhancements or revisions suggested by Quality Control (QC), Field Operations, and Family Services Specialists (FSS).

POLICY

New DFA Form 800R[EFS], Extended Food Stamp (EFS) Application for Continued Eligibility for Food Stamp Benefits ONLY, will be sent to EFS recipients who must reapply for Food Stamp benefits because they are approaching the end of their 5-month EFS eligibility period. This new form replaces the procedure of sending EFS recipients an EFS-stamped DFA Form 800R, but the new process will not begin until the current supply of EFS-stamped Form 800Rs is exhausted.

In a related change, DFA Form 800R, Application for Continued Eligibility for Financial, Medical, Child Care, and Food Stamp Benefits, was also updated to incorporate enhancements suggested by QC, Field Operations, and by FSS during the May/June 2011 Listening Sessions hosted by the DFA Director and Administrator of Field Operations.

NEW HEIGHTS SYSTEMS PROCEDURES AND IMPLEMENTATION

Minor wording changes were made to the CM0023, EFS End Letter, to incorporate the new EFS application. New HEIGHTS will release the revised CM0023 under separate cover at a later date.

Additionally, new DFA Form 800R[EFS] will be added to the Document Imaging taxonomy, once it is printed, and will be trained for automatic recognition when scanned.

DESCRIPTION OF REVISIONS MADE TO FORMS

DFA Form 800R[EFS], Extended Food Stamp (EFS) Application for Continued Eligibility for Food Stamp Benefits ONLY

New DFA Form 800R[EFS], Extended Food Stamp (EFS) Application for Continued Eligibility for Food Stamp Benefits ONLY, is a two-page, two-sided printed form used only for EFS recipients who are approaching the end of their 5-month EFS eligibility period and therefore must reapply for Food Stamp benefits. This form was based on DFA Form 800R but will be printed on plain white paper because the paper color of the form, previously used as a visual cue for District Office workers, is not needed now that it is a separate form.

The form provides information necessary to reassess Food Stamp benefit eligibility when the EFS period is expiring, and is mailed from the Brown Building Mail Room in mail job PNCN74EF. The following inserts are included in this mail job:

·   New HEIGHTS-generated CM0023, EFS End Letter;

·   DFA Form 800R[EFS], Extended Food Stamp (EFS) Application for Continued Eligibility for Food Stamp Benefits ONLY;

·   DFA Form 811R, Application: Your Rights and Responsibilities; and

·   A Centralized Scanning Unit (CSU) postage-paid District Office-specific return envelope.

DFA Form 800R[EFS] contains an explanatory cover letter and a verification check-off list in tear-off format that clients can retain for reference. The recipient:

1. completes the DFA Form 800R[EFS] according to the instructions given on the form;

2. signs and dates DFA Form 800R[EFS];

3. attaches copies of verifications, if applicable and available, and mails DFA Form 800R[EFS] in the postage-paid CSU return envelope provided with the form, prior to the 10th of the recertification month; and

4. retains the tear-off cover letter/verification check-off list for their records.

Instructions for new DFA Form 800R[EFS] were created accordingly.

DFA Form 800R, Application for Continued Eligibility for Financial, Medical, Child Care, and Food Stamp Benefits

DFA Form 800R, Application for Continued Eligibility for Financial, Medical, Child Care, and Food Stamp Benefits, was revised as follows:

·   The title of the form was altered to include Child Care.

·   The following additional text was added to the first paragraph of the form:

You must complete this Application for Continued Eligibility if you want to find out if you are eligible to continue to get your benefits. We will accept this Application even if you only fill in your name, address, and signature. However, we will be able to figure out if you can continue to get your benefits much quicker if you complete this entire Application.

·   The language was simplified throughout the form to bring it closer to an 8th grade reading level.

·   To encourage the return of DFA Form 800R earlier and help prevent recipients from losing eligibility and/or experiencing a delay in receipt of benefits to which they are entitled and eligible, text only was changed from "the 15th of next month" for returning the DFA Form 800R and associated required proofs to "the 10th of next month." Policy does not change:

-   Food Stamp recipients still have until the end of their certification period to complete the recertification process, per Food Stamp Manual (FSM) 161.05, Processing Redeteminations/Recertifications;

-   Financial Assistance to Needy Families financial and medical assistance recipients still have until the 15th of the last month of their redetermination period to complete the redetermination process, per Family Assistance Manual (FAM) 161.05, Processing Redeteminations/Recertifications; and

-   Adult category financial and medical assistance recipients still have until the 25th of the last month of their redetermination period to complete the redetermination process, per Adult Assistance Manual (AAM) 155.05, Required Verification for Redetermination.

·   Text about NH Fuel Assistance (FA) associated with certain Food Stamp Program deductions was revised in both shaded sections on DFA Form 800R:

-   On the back of the first page of DFA Form 800R (the client tear-off sheet), where the first shaded "Special Food Stamp Income Deduction" section is located, the text related to providing proof associated with a Food Stamp income deduction for FA under the Housing and Utility Expenses sub-header, was revised to read as follows:

Statement that you intend to apply for NH Fuel Assistance (FA) OR proof that you have applied for FA, are currently getting FA, or have received FA in the last 12 months.

-   Text was additionally clarified in the following sections:

1. Because the Food Stamp Program Medical deduction is allowed with proof of incurred costs, text under the Medical Expenses subheader was expanded to clearly state that both bills, representing unpaid but incurred expenses, and receipts, representing paid expenses, satisfy the verification requirements.

2. Because the Food Stamp Program Utility Standard deduction is only allowed with proof of actual payment of a housing/utility expense, text under the Housing and Utility Expenses sub-header was modified to clearly state that only receipts, representing paid expenses, satisfy the verification requirements.

-   The FA text in section 7 of the actual Application was additionally revised to read as follows:

Do you plan to apply for Fuel Assistance (FA)? Yes No

If Yes, you may be eligible for more Food Stamp benefits. If No, answer the next question:

Have you applied for FA OR do you currently get FA OR have you gotten FA in the last 12 months?  Yes No

If Yes, you may be eligible for more Food Stamp benefits.

-   The last paragraph in section 7 was also expanded to add the following text: We will not call you or send you any further notice to get this information from you. QC suggested adding this statement following a QC arbitration case involving a mail-in redetermination. This new text will now clearly indicate that the Department has adequately informed the Food Stamp household that a deduction expense has to be both reported and verified, and that the onus is entirely on the household (not the Department) to take both of these actions if the household would like these deductions.

·   The following additions were made to DFA Form 800R to support the statewide implementation of NH EASY (see DFA SR 11-09, dated January 2011, for more information):

-   The following text was added to the What Will Happen Next section on the coversheet of the application:

If on your application you tell us you want to "Go Green," you will get all future notifications from us through your NH EASY account. Going Green means your notices are paperless – you get your notices electronically. This means you get your notices faster than through "snail mail." Your notices and letters from us will be visible on one screen. Plus, you are helping the environment! After you Go Green, we will email you any time you have a notice using the email address you give to us. Go to https://nheasy.nh.gov for more information.

-   Additionally, a field was added to Section 1, About You and Where You Live, to collect the recipient’s email address and to ask if the applicant would like to Go Green.

-   The following new Statement of Understanding was added to the signature section on the last page of the application:

I understand that if I choose to Go Green, this means that I will get future notifications from DFA through my NH EASY account, and will no longer get paper notices. DFA will email me when I have these notices using the email address I gave above. I understand that if I do not want to go paperless, I can go back to getting paper notices though my NH EASY account or by writing to my caseworker.

-   The addition of the above Going Green statement of understanding resulted in the elimination of the two following Statements of Understanding due to spacing issues:

1. This is only a review for benefits that I am currently getting. If I want to apply for other benefits, I understand that I must contact my District Office for more information. It was determined that this statement could be eliminated because earlier in the DFA Form 800R, text indicates that if the applicant wants to apply for any new benefits the Form 800R cannot be used, and the applicant is directed to contact the District Office for more information.

2. I understand that my case may be selected for a quality control review, which is an in-depth investigation of my household’s eligibility and benefit level and that I must cooperate or my benefits will end. It was determined that this statement could be eliminated because each DFA Form 800R is sent with DFA Form 811R, Application: Your Rights and Responsibilities, and this form contains text describing Quality Control reviews and the consequences to the household for failure or refusal to cooperate in these reviews.

·   The student column in Section 2, About the People You Live With, was expanded to request the grade level of the individual, if the individual is a student. This addition was requested by the field during the May/June 2011 Listening Sessions hosted by the DFA Director and Administrator of DFA Field Operations. It was indicated that New HEIGHTS requires this information and it will save staff resources to collect the information on DFA Form 800R, rather than having to take time to follow-up with the recipient.

·   Child Support was added to the list of examples of types of income in Section 3, About Your Job and Income. This addition was requested by the field during the May/June 2011 Listening Sessions hosted by the DFA Director and Administrator of DFA Field Operations.

·   Bonds and Trusts were added to types of resources a recipient must claim in Section 4, About All Your Assets. This addition was requested by the field during the May/June 2011 Listening Sessions hosted by the DFA Director and Administrator of DFA Field Operations.

·   The following text was added to Section 5, About Your Medical Coverage, after the question Do you or any household member have health insurance other than Medicaid?: (such as private insurance, dental, vision, or prescription coverage). The addition of this parenthetical text was at the request of the field during the May/June 2011 Listening Sessions hosted by the DFA Director and Administrator of DFA Field Operations.

·   The following sentence was added to the last Statement of Understanding bullet on the final page of the application: I can choose to have an attorney or other person represent me at an Administrative Appeal. DHHS will not pay for the cost of any legal services, however I understand that there is free and reduced cost legal services available in NH. This text was added based on a suggestion from the Federal level of the Food Stamp Program.

The color of this form, blue, will not be changed although it is scanned in black and white. The visual cue of the blue paper is still helpful to Mail Services when determining the inserts for the mail-in redetermination process. Instructions for this form were updated as needed to incorporate the revisions described above.

District Office staff must use up the old version of DFA Form 800R until the supply is depleted. Once the current supply of DFA Form 800R is exhausted, the new version will be printed. All prior official versions of this form are still valid, and must be acted upon according to policy.

POLICY MANUAL REVISIONS

Revised Family Assistance Manual Topics

PART 109  APPLICATION PROCESS

Section 109.01  Filing an Application

Section 161.01  Timely Notice

Section 161.05  Processing Redeterminations/Recertifications

Revised Adult Assistance Manual Topics

Section 155.01  Timely Notice

Section 155.03  Termination at Redetermination

Section 155.05  Required Verification for Redetermination

Revised Food Stamp Manual Topics

Section 161.01  Timely Notice

Section 161.05  Processing Redeterminations/Recertifications

Section 249.13  Terminating Extended Food Stamps (EFS)

IMPLEMENTATION

The Department’s Mail Services will begin to use new DFA Form 800R[EFS] in mail job PNCN74EF when the current supply of EFS-stamped DFA Form 800Rs has been exhausted.

The old version of DFA Form 800R must continue to be used until the supply is depleted. Once the current supply of DFA Form 800R is exhausted, the new version will be printed. All prior official versions of this form are still valid, and must be acted upon according to current policy.

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 manuals.

DISTRIBUTION

This SR will be distributed according to the electronic distribution list for Division of Family Assistance policy releases. This SR, and revised On-Line Manuals, 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 30, 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, Food Stamp, and Forms Manuals.

DFA/JBV:s