SR 97-31 Dated 08/97

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR revises Form 800P, Application for Low Income Pregnant Women and Children, and Form 800P(i), Instructions for Form 800P. Form 800P is distributed by outreach clinics and hospitals to enable low income pregnant women and children to apply for medical assistance through the clinic.

POLICY

Form 800P has been revised as follows:

 The title has been changed to delete a reference to children born on or after September 30, 1983;

 The Division of Human Services has been replaced with the Division of Transitional Assistance throughout the headings and text;

 The text on retroactive medical assistance has been revised to reflect date specific eligibility provisions which were released by SR 96-14;

 The term day care has been replaced with child care; and

 The section on filing discrimination complaints has been revised to show that complaints should be referred to the Controller. Previously, such complaints were referred to the Assistant Commissioner.

Form 800P(i) has been revised to reflect changes in terminology and has been reformatted as appropriate.

IMPLEMENTATION

The revised Form 800P is effective August 1997. Current supplies of this form may be used until they are depleted. As a result, no Certificate of Destruction is included in this SR. Revised forms should be available in late August and may be obtained through existing procedures.

CLIENT NOTIFICATION

No client notification is planned.

TRAINING

No training is planned.

POSTING INSTRUCTIONS

DISPOSITION

This SR may be destroyed after its contents have been noted and its posting instructions have been carried out.

DISTRIBUTION

The SR is being distributed to all holders of the Family Assistance and Forms Manuals and to selected individuals within the Office of Health Management (formerly known as Public Health). This SR is also being distributed to outreach clinics and hospitals throughout the state that use Form 800P.

KW/DTA/SJC:s