109 APPLICATION PROCESS SR 09-07, 04/09 (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 NHEP orientation, 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 anyone requesting it.

• Form 800P, Application for New Hampshire Healthy Kids Medical Insurance or Medical Coverage for Pregnant Women, can be provided 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.

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. No face-to-face interview is required. Authorized providers will furnish and accept Form 800P on site.

Prior to giving or mailing Form 800P to the applicant, advise the individual of the availability of other DFA programs. If the individual chooses to use Form 800P, offer the opportunity for a personal interview and provide the applicant 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 a face-to-face interview or attendance at the NHEP orientation may be required.

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.

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 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

Most applicants of FANF cash are additionally required to attend an NHEP orientation as a condition of eligibility for cash assistance. See Section 808.15, Orientation.

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.