SR 12-03 Dated 03/12

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

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

·   DFA Form 77I(Bo), Financial Assistance to Needy Families and Lump Sum Payments;

·   DFA Form 77J(Bo) and DFA Form 77J(Sp), In and Out Medical Assistance;

·   DFA Form 77T(Bo) and DFA Form 77T(Sp), Want to Make your Dreams Come True?;

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

·   DFA Form 800V(Bo) and DFA Form 800V(Sp), Examples of Acceptable Proofs.

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 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, 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

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 April 2, 2012. Additionally, this SR will be distributed under separate cover to all internal hard copy holders of the Forms Manual.

DFA/JBV:s