109 APPLICATION PROCESS SR 06-12, 10/06 (FAM-A) |
To complete the application process, the applicant must do all of the following:
• complete an application;
• participate in an eligibility interview and attend an orientation to NHEP, 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.
• Give paper Form 800, Application for Assistance, to anyone requesting it.
• Give Form 800P, Application for New Hampshire Healthy Kids Medical Insurance or Medical Coverage for Pregnant Women, to clients who only want to apply for:
- MCPW: Medical Coverage for Pregnant Women;
- HKG-185: Healthy Kids-Gold medical coverage for children aged 0-19 with family income no higher than 185% of federal poverty income guidelines,
- HKG-300: Healthy Kids-Gold medical coverage for infants up to age 1 with family income greater than 185%, but no higher than 300%, of federal poverty income guidelines, and
- HKS: Healthy Kids-Silver medical insurance coverage (Department subsidized) for children aged 1-19 with family income greater than 185% but no higher than 300% of federal poverty income guidelines.
No face-to-face interview is required.
Households may apply for MCPW, HKG-185, HKG-300, and HKS at the District Office, participating local health facilities, contract agency clinics funded by the Department of Public Health Services, and other authorized agencies or organizations. Authorized providers will furnish and accept Form 800P on site.
Prior to giving or mailing Form 800P to the client, advise the client of the availability of other DFA programs. If the client chooses to use Form 800P, offer the client the opportunity for a personal interview, and provide the client with a clear explanation of the application process and verification requirements associated with Form 800P.
Form 800P is used to apply for MCPW, HKG-185, HKG-300, and HKS only. If the client wishes to apply for additional programs of assistance, Form 800 must be completed and an interview or attendance at the NHEP orientation may be required.
Completing an Application
A completed application must, at minimum, contain the applicant’s name, address, signature, and type of assistance requested.
The application may be completed in the District Office or may be mailed to the individual if the individual contacts the District Office by telephone, mail, or fax and does not want to come to the office to file an application on the same day. The application must be mailed to the individual the same day of the request.
Application Filing Date
The official Filing Date for applications completed in the District Office is the date when the application is completed as described above. 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.
The official Filing Date for applications arriving via mail is the day that the completed application is received by the District Office (also see Section 109.01, Filing an Application).
Eligibility Interview
Most applicants are required to also participate in a detailed interactive Application Entry (AE) eligibility interview with a Family Services Specialist (FSS). See PART 127, INTERVIEWS.
NHEP Orientation
Applicants for NHEP/UP financial assistance are additionally required to attend an orientation to NHEP as a condition of eligibility for cash assistance.
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 129, PENDING INFORMATION.