SR 11-42 Dated 11/11

 

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

 

DFA SIGNATURE DATE:

November 3, 2011

FROM:

OFFICE OF THE DIRECTOR, DFA Terry R. Smith

AT (OFFICE):

Division of Family Assistance

TO:

DFA Supervisors

NHEP teams

District Office Managers of Operations

 

SUBJECT:

Release of the Following Revised Bosnian and Spanish Language Versions of DFA Forms: DFA 77a(Bo) and DFA Form 77a(Sp), Financial and Medical Assistance to Needy Families (FANF), DFA Form 77c(Bo) and DFA Form 77c(Sp), NH State Supplement Program; DFA Form 260(Bo) and DFA Form 260(Sp), Financial Assistance to Needy Families (FANF) Fact Sheet, DFA Form 800(Bo) and DFA Form 800(Sp), Application for Assistance, DFA Form 800A(Bo) and DFA Form 800A(Sp), DFA Programs and Services Guide, and DFA Form 811R(Bo) and DFA Form 811R(Sp), Application: Your Rights and Responsibilities

EFFECTIVE DATE:

November 30, 2011

 

 

SUMMARY

 

This SR releases the Bosnian and Spanish language versions of the following forms to align with recent updates to the corresponding English versions:

 

·   DFA Form 77a(Bo) and DFA Form 77a(Sp), Financial and Medical Assistance to Needy Families (FANF);

·   DFA Form 77c(Bo) and DFA Form 77c(Sp), NH State Supplement Program;

·   DFA Form 260(Bo) and DFA Form 260(Sp), Financial Assistance to Needy Families (FANF) Fact Sheet;

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

·   DFA Form 800A(Bo) and DFA Form 800A(Sp), DFA Programs and Services Guide; and

·   DFA Form 811R(Bo) and DFA Form 811R(Sp), Application: Your Rights and Responsibilities.

 

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

 

POLICY

 

The Bosnian and Spanish versions of the forms released in this SR are now aligned with recent updates to the corresponding English versions of these forms. Therefore, the SR number and date of the translated forms released in this SR will match the English versions of the forms. Because the Bosnian and Spanish language versions of the forms released in this SR are used in the same manner as the English versions, no form instructions are being re-released.

 

All supplies of the old versions of these forms in the District Offices may be recycled upon receipt of the new versions.

 

IMPLEMENTATION

 

An initial supply of each of the translated forms released in this SR has been sent to each District 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, and Littleton, District Offices.

 

Once copies of the newly translated forms released by this SR are received, District 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.

 

All supplies of the old versions of these forms in the District Offices may be recycled upon receipt of the new versions.

 

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

 

 

 

DFA Form 77a(Bo), Financial and Medical Assistance to Needy Families (FANF),

DFA SR 08-04/April, 2008, Rev 8/11

1 back-to-back sheet

DFA Form 77a(Bo), Financial and Medical Assistance to Needy Families (FANF),

DFA SR 11-30/July, 2011

1 back-to-back sheet

DFA Form 77a(Sp), Financial and Medical Assistance to Needy Families (FANF),

DFA SR 08-04/April, 2008, Rev 8/11

1 back-to-back sheet

DFA Form 77a(Sp), Financial and Medical Assistance to Needy Families (FANF),

DFA SR 11-30/July, 2011

1 back-to-back sheet

DFA Form 77c(Bo), NH State Supplement Program, SR 08-06/October, 2008, Rev 04/10

1 back-to-back sheet

DFA Form 77c(Bo), NH State Supplement Program, DFA SR 11-26/July, 2011

1 back-to-back sheet

DFA Form 77c(Sp), NH State Supplement Program, SR 08-06/October, 2008, Rev 04/10

1 back-to-back sheet

DFA Form 77c(Sp), NH State Supplement Program, DFA SR 11-26/July, 2011

1 back-to-back sheet

DFA Form 260(Bo), Financial Assistance to Needy Families (FANF) Fact Sheet,

DFA SR 09-11/October, 2009

1 back-to-back sheet

DFA Form 260(Bo), Financial Assistance to Needy Families (FANF) Fact Sheet,

DFA SR 11-30/July, 2011

1 back-to-back sheet

DFA Form 260(Sp), Financial Assistance to Needy Families (FANF) Fact Sheet,

DFA SR 09-11/October, 2009

1 sheet

DFA Form 260(Sp), Financial Assistance to Needy Families (FANF) Fact Sheet,

DFA SR 11-30/July, 2011

1 sheet

DFA Form 800(Bo), Application for Assistance, DFA SR 10-11/January, 2010

4 back-to-back sheets

DFA Form 800(Bo), Application for Assistance, DFA SR 11-15/March, 2011

4 back-to-back sheets

DFA Form 800(Sp), Application for Assistance, DFA SR 10-11/January, 2010

4 back-to-back sheets

DFA Form 800(Sp), Application for Assistance, DFA SR 11-15/March, 2011

4 back-to-back sheets

DFA Form 800A(Bo), DFA Programs and Services Guide, DFA SR 10-03/April, 2010

4 back-to-back sheets

DFA Form 800A(Bo), DFA Programs and Services Guide, DFA SR 11-30/July, 2011

4 back-to-back sheets

DFA Form 800A(Sp), DFA Programs and Services Guide, DFA SR 10-03/April, 2010

4 back-to-back sheets

DFA Form 800A(Sp), DFA Programs and Services Guide, DFA SR 11-30/July, 2011

4 back-to-back sheets

DFA Form 811R(Bo), Application: Your Rights and Responsibilities,

DFA SR 08-17/February, 2006

1 back-to-back sheet

DFA Form 811R(Bo), Application: Your Rights and Responsibilities,

DFA SR 11-15/March, 2011

1 back-to-back sheet

DFA Form 811R(Sp), Application: Your Rights and Responsibilities,

DFA SR 08-17/February, 2006

1 back-to-back sheet

DFA Form 811R(Sp), Application: Your Rights and Responsibilities,

DFA SR 11-15/March, 2011

1 back-to-back sheet

 

DISPOSITION

 

This SR may be destroyed or deleted after its contents have been noted and the this SR has 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 December 5, 2011. Additionally, this SR, and printed pages with posting instructions, will be distributed under separate cover to all internal hard copy holders of the Forms Manual.

 

DFA/JBV:s

 

CERTIFICATE OF DESTRUCTION

I certify that the following copies of the Spanish and Bosnian version forms have been destroyed:

·   Form 77a(Bo) & (Sp), dated 4/08 or 4/08 rev 8/11, SR 08-04;

·   Form 77c(Bo) & (Sp), dated 10/08 or 10/08 rev 4/10, SR 08-06;

·   Form 260(Bo) & (Sp), dated 10/09, SR 09-11;

·   Form 800(Bo) & (Sp), dated 1/10, SR 10-11;

·   Form 800A(Bo) & (Sp), dated 4/10, SR 10-03; and

·   Form 811R(Bo) & (Sp), dated 2/06, SR 08-17.

District Office Manager of Operations:

 

District Office:

 

 

 

Return this certificate to the DFA Policy Unit, 129 Pleasant St, Brown Bldg, 3rd Floor, Concord, NH 03301, after the instructions in the SR have been carried out.