209.37 Verification of Deprivation (FAM)

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Verify any of the three causes which deprive a child of parental support or care. Also verify the parent-child relationship.

The following special verification requirements must be met:

Deprivation due to death: Use any document that reasonably proves the death. An affidavit of death used as verification must consist of signed statements by two individuals who have direct knowledge of the death. Verify the death at initial application only.

Deprivation due to continued absence: The individual must complete BFA Form 773, Certification of Continued Absence. Verify continued absence using BFA Form 773 at initial application, whenever continued absence is questionable, and when appropriate (such as when the 30 days have been broken).

Deprivation due to incapacity: Verify incapacity with the following:

·    if the individual is currently eligible for Aid to the Permanently and Totally Disabled (APTD), Aid to the Needy Blind (ANB), Supplemental Security Income (SSI), or Social Security Disability Insurance (SSDI), the individual does not need to complete BFA Form 720.

·    if the individual is NOT currently receiving APTD, ANB, SSI, or SSDI, use the following verification process:

o  provide the individual with BFA Form 720, Determination of Incapacity for FANF Financial Assistance; the information requested on this form must be provided by his or her authorized healthcare provider;

o  set a review date for the end of the incapacity (a date for the end of the incapacity is noted by the authorized healthcare provider) or for the first redetermination, whichever is earlier; and

o  verify incapacity at initial application, each redetermination of eligibility, and whenever a change in incapacity occurs.

Healthcare providers authorized to provide the information requested on BFA Form 720 are currently licensed:

·    Physicians;

·    Physician Assistants;

·    Advanced Practice Registered Nurses;

·    Psychologists (board certified);

·    Pastoral Psychotherapists;

·    Alcohol and Drug Counselors (Master Licensed Alcohol and Drug Counselors only);

·    Independent Clinical Social Workers;

·    Clinical Mental Health Counselors; and

·    Marriage and Family Therapists.

Required information (as listed on BFA Form 720:

·    a statement by an authorized healthcare provider that indicates whether an incapacity exists, and if it does exist:

o  the date when the incapacity began, ended, or is expected to end; and

o  the diagnosis, examination date, and current and recommended medical treatment; and

·    the name, address, phone number, profession, and dated signature of the authorized healthcare provider.

Failure to comply: Failure to comply with verification requests results in the denial or termination of financial assistance for the entire case.

References: He-W 627.01; He-W 628.02; RSA 167:6, V; RSA 167:79; 45 CFR 233.90