109 APPLICATION PROCESS SR 09-07, 04/09 (AAM-A)

To complete the application process, the applicant must do all of the following:

• complete an application;

• participate in an eligibility interview, if required by the program of assistance requested; and

• provide all required verification within timeframes.

Individuals have the right to:

• apply for assistance;

• file an application on the same day the District Office has been contacted; and

• have an eligibility decision made on their application for assistance.

Advise individuals that they may file the application before an interview is conducted.

Requesting an Application

An individual may request an application by contacting any District Office.

• Form 800, Application for Assistance, is provided to any individual requesting an application.

• Form 800Q, Assisted Application For Help With Medicare Costs For Medicare Beneficiaries, is a mail-in application used *by New Hampshire Housing Authority (NHHA) residents and certain other individuals to apply for the Qualified Medicare Beneficiary (QMB), Special Low Income Medicare Beneficiary (SLMB), Special Low Income Medicare Beneficiary at 135% of federal poverty income guidelines (SLMB135), and Qualified Working and Disabled Individual (QDWI) programs.

An individual may request and receive Form 800 by contacting any District Office. If the individual contacts the District Office by telephone, fax, or mail, and does not want to come to the office to file an application on the same day, direct the individual to the Department’s website, so that a Form 800 can be printed off immediately for the individual’s use. If the individual does not have access to a computer or the Internet, mail Form 800 to the individual on the same day the request is received.

Completing an Application

A completed application must, at minimum, contain the applicant’s name, address, signature, and type of assistance requested.

Individuals may also apply for assistance at hospitals by completing and submitting Form 800, Application for Assistance.

Application Filing Date

The official Filing Date for applications * is the date when the application is completed as described above and received by the District Office. This date is stamped onto the official application, and entered onto the "coversheet" of the Form 800 before the coversheet is returned to the applicant for reference. Also see Section 109.01, Filing an Application.

Eligibility Interview

Most applicants, including applicants for nursing facility care, are required to also participate in a detailed interactive Application Entry (AE) eligibility interview with a Family Services Specialist (FSS). See PART 121, INTERVIEWS.

Required Verification

All applicants must provide verification of information related to benefit eligibility and allotment amount that the individual provided on the application or to the FSS during the interview. See PART 123, PENDING INFORMATION.