SR 15-10 Dated 02/15

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR releases the obsolescence of DFA Form 789, Resource Information Sheet, and its associated instructions. Previously, DFA Form 789 was used to meet the Department’s legal obligations resulting from the 1985 Clark v. Dupuis consent decree to provide information to applicants and recipients regarding which resources were considered available to the assistance group and the countable value of each resource. After review by DHHS legal staff and Financial Assistance to Needy Families (FANF), Food Stamp, Medicaid, and State Supplement (SSP) program area experts, it was decided that this form is no longer needed due to the availability of client resource information provided to applicants and recipients on the Eligibility Interview Summary (EIS) generated out of New HEIGHTS, as well as from information accessible through clients’ online NH EASY accounts.

BACKGROUND

DFA Form 789 was originally released in 1985 (SR 85-60) as an AFDC cash/medical-only form in response to the Clark v. Dupuis consent decree. Among other proscriptions regarding legal requirements of Notices of Decision, Clark v. Dupuis mandated that the Department provide a written form to all clients, at initial interviews and redeterminations, of “…the specific resources the Division considers the person to possess and the assessed value of said resources.” SR 87-40 released a redesigned version of the form that included resource information for Food Stamps and State Supplement cash and medical programs as well as AFDC. DFA Form 789 was re-released in 1997 (SR 97-08) to reflect changes to programs brought about by the Personal Responsibility and Work Opportunities Act (PRWORA) of 1996, including replacing references to “AFDC” with ”TANF” and updating resource limit information. DFA Form 789 was last updated as part of SR 01-34.

POLICY

DFA Form 789 is obsolete with the release of this SR. Recent DHHS legal analysis and program area specialist review of Clark v. Dupuis determined that the legal requirements stated in the lawsuit’s consent decree are being met through the New HEIGHTS-generated EIS which must be provided to each applicant or recipient following the initial application or redetermination of eligibility. The EIS is also available electronically in each individual’s NH EASY account.

District Offices can recycle any version of this form in their possession. A Certificate of Destruction has been included in this SR.

NEW HEIGHTS SYSTEMS PROCEDURES AND DISTRICT OFFICE IMPLEMENTATION

Formerly, DFA Form 789 was manually provided to applicants and recipients and was never generated from New HEIGHTS. The purpose of DFA Form 789 is now being fulfilled through the generation of the EIS. Family Services Specialists must ensure that the signed and initialed EIS is provided to all applicants and recipients at the initial application eligibility determination and subsequent redetermination interview. Applicants and recipients with NH EASY accounts may also view their EIS information online.

UNRELATED POLICY CLARIFICATION

Manual pages in the Family Assistance (FAM), Adult Assistance (AAM), and Medical Assistance (MAM) Manuals regarding jointly owned resources have been updated as follows as part of this policy release. The policy in these manuals for jointly owned resources established on or after November 1, 1995 currently reads: “When one or more joint owners apply for or are receiving assistance…” For clarification purposes, the wording has been changed to: “If more than one of the joint owners apply for or are receiving assistance…”

POLICY MANUAL REVISIONS

Revised Adult Assistance Manual Topics

Section 109.03  Processing a Filed Application

PART 411  COMMON TYPES OF RESOURCES: JOINTLY OWNED PERSONAL PROPERTY

Revised Family Assistance Manual Topics

Section 109.03  Processing a Filed Application

PART 409  COMMON TYPES OF RESOURCES: JOINTLY OWNED RESOURCES

Revised Food Stamp Manual Topics

Section 109.03  Processing a Filed Application

Revised Medical Assistance Manual Topics

Section 109.03  Processing a Filed Application

PART 411  COMMON TYPES OF RESOURCES: JOINTLY OWNED PERSONAL PROPERTY

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 March 2, 2015. 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, Family Assistance, Food Stamp, Forms, and Medical Assistance Manuals.

DFA/SMC:s