SR 00-08 Dated 02/00

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR releases policy based upon the newly adopted Family Violence Option (FVO) specifying the exemptions, waivers, and special considerations provided to TANF applicants or recipients whose family includes a member who is or has been a victim of family/domestic violence. This SR also releases standardized procedures and documentation required to process and verify client requests for the Family Violence Options. The standardized verification process includes the new provision that if a current or past victim of family/domestic violence is unable to provide the specified documentation, a signed statement by the client submitted on new Form 754C, Request for TANF Family/Domestic Violence Option, is acceptable documentation of the violence.

This SR releases new Form 243, Maybe There is Help, and new Form 754C, Request for TANF Family/Domestic Violence Option, and their respective instructions. Both forms are explained in further detail in the FORMS section below.

This SR also revises the following forms and their respective instructions to incorporate new family/domestic violence policy:

 Form 77a, The New Hampshire Employment Program and the Family Assistance Program: Financial and Medical Assistance to Families with Dependent Children;

 Form 221, The New Hampshire Employment Program;

 Form 242, The 60 Month Lifetime Limit on TANF Financial Assistance: What You Need to Know;

 Form 754A, Your Right to Claim Good Cause;

 Form 754B, Good Cause Claim;

 Form 780, Good Cause Decision Sheet; and

 Form 781, Good Cause Claim/FVO Decision.

Revisions to FAM 100, 300, and 800 to reflect the new policy are also released by this SR, as are unrelated technical corrections and policy clarifications made to those chapters.

BACKGROUND

In October 1996 the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) was passed, allowing the federal government to permit individual states, through the Family Violence Option (FVO), to choose whether they would allow waivers of certain TANF program requirements to victims of family/domestic violence.

States adopting the FVO in their TANF state plan are required to identify the specific TANF program requirements that will be exempted or waived and specify the criteria upon which the exemptions will be granted. Federal regulations provide the parameters for the exemptions that are offered and the criteria upon which the exemptions are granted.

The families requesting the exemptions or waivers must also document that compliance with the specified TANF program requirements would make it more difficult for them to escape the family/domestic violence, unfairly penalize them, or place them at further risk of family/domestic violence.

Preparation for the implementation of the FVO in NH was coordinated over a 3 year period with the Division of Family Assistance, Division of Child Support Services, Division of Children, Youth, and Families, NH Legal Assistance, and the NH Coalition Against Domestic and Sexual Violence. In February 2000, the Department of Health and Human Services (DHHS) adopted the FVO, effectively expanding NHEP/FAP services for families suffering from family/domestic violence by providing these families with the comprehensive support they need to begin their preparations for a life of economic self-sufficiency.

POLICY

Revised Family Assistance Manual Topics

Part 133 LENGTH OF ELIGIBILITY

Section 303.09 Out-of-State Recipient Moves into New Hampshire

Section 305.01 Definition of U.S. Citizen

Section 305.09 Determining Qualified Alien Status

Section 305.13 Qualified Aliens Eligible Without Restriction

Section 305.17 Qualified Aliens with Restricted Eligibility Based on Date of Entry into the U.S.

Section 311.17 Good Cause for Non-Cooperation

Section 311.19 Good Cause: Acceptable Reasons

Section 311.23 Good Cause: Notifying the Division of Child Support Services (DCSS)

Section 311.25 Good Cause: Verification

Section 315.01 Definition of Voluntary Quit

Section 315.05 Sanctions/Disqualifications for Voluntary Quit

Section 315.07 Informing the Household about Voluntary Quit

Section 315.11 Reapplication/Reinstatement after Voluntary Quit

Section 808.05 Exemptions from Participation in NHEP

Section 808.07 Verification of Exemptions

Section 808.09 Referral to NHEP Teams

Section 808.17 Assessment

Section 808.31 Compliance Requirements

Section 808.33 Conciliation Process

Section 808.35 Sanctions for Failure or Refusal to Cooperate with NHEP Work Program Participation Requirements

Section 808.37 Participation Requirements for 2 Parent Families

Summary of Policy Changes Associated with the Family Violence Option

Current policy allows victims of family/domestic violence to request exemptions or waivers from:

 cooperation with child support requirements;

 the 60-month lifetime limit on receipt of financial assistance; and

 the 12-month period of ineligibility when an out-of-state recipient moves into NH.

New policy released by this SR:

 clarifies and expands upon the current policies listed above;

 provides victims special consideration in NHEP by adding a provision allowing a victim to be excused from all NHEP activity participation requirements for six months, with possible renewal of the 6-month participation hiatus;

 adds the specification that if a victim of family/domestic violence is unable to obtain acceptable documentation, they may provide a written statement on new Form 754C; and

 standardizes the procedures and documentation required to process and verify a request to waive TANF-related program requirements due to family/domestic violence.

Standardized Procedures and Documentation

With the release of this SR, all client requests for exemptions, waivers, or special considerations due to family/domestic violence must be submitted on new Form 754C, Request for TANF Family/Domestic Violence Option. New Form 754C specifies that clients who disclose that they are unable to comply with TANF program requirements because the client’s family includes a member who is, or has been, a victim of family/domestic violence may verify their claim with any of the following documentation:

 court, medical, criminal, child protective services, social services, psychological or law enforcement records;

 a written statement from a public or private social agency;

 a written statement from a public or private social agency providing family/domestic violence services; or

 sworn statements from individuals, other than family members, knowledgeable of the circumstances.

If the client is unable to provide the specified documentation, the Division of Family Assistance (DFA) must accept as verification the client’s signed statement on Form 754C confirming the violence and indicating that compliance with program requirements would:

 make it more difficult for the family to escape the family/domestic violence;

 unfairly penalize the family who is or has been victimized by such violence; or

 put the family at further risk of family/domestic violence.

Note: The Instructions for Form 754C provide detailed procedures for the District Office and for the NHEP team to use to provide applicants and recipients the opportunity to request an FVO. It cannot be stressed too firmly that all requests for family/domestic violence options must be treated seriously, and be handled with the utmost discretion and confidentiality.

Clarifications and Revisions to Policy and Procedures

Cooperation with Child Support Requirements

A claim of good cause due to "family/domestic violence" has been added to the acceptable good cause reasons for non-cooperation with child support specified in existing policy.

Note: A claim of good cause due to family/domestic violence does not replace a claim of good cause for non-cooperation due to emotional or physical harm, and the criteria to claim and verify these latter two good cause reasons remains essentially unchanged. However, applicants may select either of these latter two good cause reasons for more specific circumstances than under previous policy. Specifically, a good cause claim due to physical or emotional harm to the applicant or child should now be used when the harm, or threat of harm is not due to a family/domestic violence situation. For example:

 an applicant might make a claim on the basis of physical harm because a non-relative of the non-custodial parent (e.g., a neighborhood friend, a co-worker, etc.) has made threats to the physical safety of the applicant or child; or

 an applicant might make a claim on the basis of emotional harm because he or she has a documented history of psychiatric illness or emotional distress that would be sufficiently exacerbated by paternity establishment proceedings to prevent him or her from providing adequate care to the child.

The choice of either of these reasons does not require the completion of Form 754C.

Procedures

All claims for good cause for non-cooperation with child support requirements due to family/domestic violence must be accompanied by Form 754C and required documentation. If the claim is made at the District Office in the course of the interactive interview, an indication on Form 754B of family/domestic violence as the good cause reason will automatically result in completion of Form 754C. Conversely, if the individual, while pursuing special considerations of NHEP work requirements due to family/domestic violence with NHEP team, wants to also claim good cause for non-cooperation with child support for the same reason, he or she is referred to the case technician for completion of 754B and 754C.

 If an applicant or recipient claims good cause for non-cooperation with child support requirements, provide the individual with Form 754A, Your Right to Claim Good Cause, and Form 754B, Good Cause Claim.

 If the individual is claiming good cause due to family/domestic violence, he or she must also complete Form 754C, Request for TANF Family/Domestic Violence Option, and provide required verification as explained on the form.

 If the individual reveals a family/domestic situation to the NHEP team and, at that time, also wishes to claim good cause for non-cooperation with child support, instruct the client to contact his or her case technician for completion of Forms 754B and 754C at the District Office.

Note: Form 754C also provides the individual the opportunity to request a waiver due to family/domestic violence of the TANF 60 month time limit and to request special considerations if referred to NHEP work programs. If the individual wishes to make these requests at the same time as a claim of good cause for non-cooperation with child support requirements by so indicating on Form 754C, follow the instructions for Form 754C regarding distribution of copies of the form. See the FORMS section of this SR for further information on new Form 754C and revised Form 754B and an important cautionary instruction regarding the security and privacy of Form 754C.

Interim New HEIGHTS Procedures for Entering Good Cause for Non-Cooperation with Child Support

At this time there are no immediate plans to add "family/domestic violence" to the drop down menu on the Good Cause section of the Non-Custodial-Parent/Custodial Parent Cooperation Information screen. Therefore, when an applicant claims good cause for non-cooperation with child support due to family/domestic violence, use the following procedures:

 In the drop down box in the Good Cause section of this screen, select "physical harm" or "emotional harm" as the good cause reason and document in the record that the reason for the claim is family/domestic violence. Make certain that Form 754C is properly completed, signed, and included in the case record along with any additional documentation of family/domestic violence.

 Once Form 754C and all required verification has been provided and a good cause decision made via Form 780, Good Cause Decision Sheet, complete this screen by indicating the decision date and whether the DFA Supervisor has granted good cause.

60-Month Lifetime Limit on Receipt of Financial Assistance

A current recipient, or former recipient whose case closed after receiving 60 months of financial assistance, whose family includes a member who is or has been a victim of family/domestic violence, may request an exemption from the 60-month lifetime limit on receipt of financial assistance. This SR clarifies current policy by substituting "family/domestic violence" for "battering or extreme cruelty" as the exemption criterion for the 60-month limit and adds standard procedures and documentation required to provide this exemption.

Per federal regulations, exemptions from the 60-month lifetime limit cannot be granted until the lifetime limit has been reached and the request for exemption approved (see below). Since the TANF program in New Hampshire began effective October 1, 1996, the first time a family in NH could reach the 60-month limit is September 30, 2001. Specific procedures for notifying TANF recipients approaching the 60-month limit have yet to be determined and will be released in a future SR.

Note: While the process for evaluating exemption requests has not been finalized, it is the intention of the Division of Family Assistance that TANF recipients whose family includes a member who is or has been a victim of family/domestic violence apply for the exemption prior to exhausting benefits and, if found eligible, have no break in financial assistance. It is the Division’s plan to create an eligibility determination process with appropriate timeframes to allow all families eligible for all exemptions to the 60-month time limit to continue receiving benefits with no break in service.

For the exemption request to be considered, the family will be required to do the following:

 complete the family/domestic violence verification process explained in the Standardized Procedures and Documentation section above; and

 participate in the following:

 an individualized assessment; and

 the development of an individualized service plan.

A person trained in family/domestic violence must complete both the individualized assessment and the individualized service plan with the client. The assessment will determine if the exemption is granted. If the individual refuses to participate in this assessment or in the development of their service plan, the exemption from the 60-month lifetime limit is denied.

12-Month Period of Ineligibility When an Out-of-State Recipient Moves into NH

The current "interstate migration" policy remains the same; victims of family/domestic violence retain their eligibility for a waiver of the 12-month period of ineligibility when they move to NH. The verification process, however, has been standardized with the release of this SR. See Standardized Procedures and Documentation.

NHEP Barrier Resolution Activity

Participation in the NH Employment Program has changed significantly under the Family Violence Option. NHEP clients will be provided with services and special considerations within NHEP when they do the following:

 disclose that their family includes a member who is, or has been, a victim of family/domestic violence; and

 request the NHEP family/domestic violence services and special considerations.

Individuals requesting the NHEP family/domestic violence services and special considerations must:

 complete the verification process (see Standardized Procedures and Documentation); and

 be referred to the NHEP Team.

An NHEP team member will offer the client the following options:

1. 6 months in which the client is excused from all NHEP activity participation requirements;

2. a referral to an agency specializing in family/domestic violence services;

3. a meeting with a person trained in family/domestic violence at the NHEP or alternative site; or

4. full participation in the NHEP and related activities.

The client may choose any combination of options 2, 3, or 4 above. If the client chooses option 1 (to be excused from NHEP participation) or option 2 (is seeking assistance for their family/domestic violence situation), the client will be enrolled automatically in the NHEP Barrier Resolution Activity.

An individual who has chosen option 1, to be excused for 6 months from all NHEP work activity requirements, must meet with an NHEP team member at the end of the 6-month period. At this time, the NHEP team member will arrange to have a local family/domestic violence counselor present to provide information concerning family/domestic violence services available in the community. Local family/domestic violence centers are prepared to assist all District Offices in the facilitation of this meeting and the dissemination of family/domestic violence information. At the conclusion of this meeting, the client will be offered the same four options from which to choose as specified above.

If the client opts to be excused from all NHEP work activity requirements for another 6 month period, at the conclusion of the 12 month period the individual will be required to meet with a person trained in family/domestic violence for an individualized assessment and development of an individualized service plan. This assessment and individualized service plan will recommend the next steps in the NHEP program. If the client refuses to participate in this assessment or in the development of the service plan, the NHEP team member will begin the non-compliance process (see FAM 808.33, Conciliation Process, and FAM 808.35, Sanctions for Failure or Refusal to Cooperate with NHEP Work Program Participation Requirements, for details about the non-compliance process).

After consulting with the client and making an assessment, the person trained in family/domestic violence will indicate on the individualized service plan one of the following options that best addresses the family’s needs:

 an additional 6 months in which the client is excused from all NHEP work activity requirements, to be reassessed every 6 months;

 required participation in NHEP activities;

 required participation in family/domestic violence services; or

 required pursuit of an alternative or permanent exemption from the NHEP (see FAM 808.05, Exemptions from Participation in NHEP).

Following the development of the individualized assessment and service plan, the person trained in family/domestic violence should be involved in all future decisions regarding the individual’s participation in NHEP activities. For example, if the person trained in family/domestic violence creates a service plan with the client after the client has been excused from NHEP participation for 12 months and specifies that the client is ready to participate in NHEP activities, the client must comply with all NHEP work requirements.

If the client does not comply with NHEP requirements and the NHEP team member requests a meeting with the client, the person trained in family/domestic violence should also be invited to attend the meeting. Similarly, the person trained in family/domestic violence should be consulted if there is a change to the individualized service plan or employability plan.

GOOD CAUSE FOR NON-COMPLIANCE WITH NHEP WORK REQUIREMENTS DUE TO FAMILY/DOMESTIC VIOLENCE

A client may claim good cause for non-compliance with NHEP work requirements due to family/domestic violence unless the client has, at any time, chosen the Family Violence Option excusing them from NHEP activity participation requirements for two 6-month periods.

If the client has chosen non-participation in NHEP for two 6-month periods, the decision made on the client’s claim should be a collaborative effort between the person trained in family/domestic violence and the NHEP team member.

RELATED TECHNICAL CORRECTIONS AND POLICY CLARIFICATIONS

Length of Eligibility: Technical Corrections & Policy Clarifications to FAM 133

 The term "battered and subjected to extreme cruelty" has been replaced with the term "family/domestic violence" to align DHHS terminology with the federal terminology of PRWORA and the TANF Family Violence Option. "Family/domestic violence" has the same meaning as "battered or subjected to extreme cruelty" when used elsewhere in the manual.

 Text was added specifying the requirements for all requests for exemptions or waivers of TANF program requirements due to family/domestic violence.

 Text was added specifying the additional criteria required for an FVO request for an exemption from the 60-month lifetime limit to be considered, described in the 60 Month Lifetime Limit on Receipt of Financial Assistance section above.

When an Out-of-State Client Moves to NH: Technical Corrections to FAM 303.09

The term "subject to battering or extreme cruelty" has been replaced with the term "subject to family/domestic violence" to align the policy with the terminology used in PRWORA and the TANF Family Violence Option.

Non-Cooperation with Child Support: Technical Corrections & Policy Clarifications to FAM 311

Numerous corrections and clarifications were made throughout Part 311 to replace obsolete references to departmental units (e.g. replacing references to "Office of Child Support Enforcement Services (OCSES)" with "Division of Child Support Services (DCSS)"), and to enhance the accuracy and clarity of inter-departmental information flow. In addition, the following revisions were made:

 In FAM 311.17, form titles were corrected and obsolete organizational references revised.

 In FAM 311.19, family/domestic violence was added to the list of acceptable reasons for non-cooperation with child support.

 Links to FAM 133, LENGTH OF ELIGIBILITY, were added throughout this section as the procedures and documentation required to verify a claim of family/domestic violence are specified and standardized in FAM 133.

 In FAM 311.25, text was added to clarify that clients may provide sworn statements when claiming good cause for non-cooperation due to physical harm if other documentation is unobtainable.

 In FAM 311.25, text referring to the requirement and method of payment for psychological assessments was removed from the verification requirements for good cause due to emotional harm because it is no longer Departmental policy.

New Hampshire Employment Program (NHEP): Technical Corrections & Policy Clarifications to Fam 808

 In FAM 808.09, text was added specifying the family/domestic violence policy changes to the NHEP program as described in the NHEP Barrier Resolution Activity and the Good Cause for Non-Compliance with NHEP Work Requirements due to Family/Domestic Violence sections above.

 In FAM 808.17, text was added to specify that during the assessment process, the client and NHEP Team Member will discuss possible barriers to employment including family/domestic violence.

 In FAM 808.31, family/domestic violence was added to the list of good cause reasons for non-compliance with NHEP participation requirements.

UNRELATED TECHNICAL CORRECTIONS AND POLICY CLARIFICATIONS

Several technical corrections and clarifications of existing policies were made to the sections of FAM 100, 300, and 800 listed below.

Out-of-State TANF Clock: Policy Clarifications to FAM 133

 Text was added to clarify that only months in which an adult, minor casehead, or minor spouse of the casehead receives TANF are counted toward the 60-month lifetime limit; months of receipt as a dependent child do not count toward an individual’s 60-month lifetime limit.

 Text was added to clarify that the 60 months of receipt of TANF financial assistance includes receipt in any state, but that the counting of the 60 months begins as of the date on which a state’s TANF Program began, defined as the date on which the state’s TANF State Plan was effective. A national chart listing the TANF State Plan effective dates for all states is included with this SR for reference. District Offices and Profile Teams were also provided with a copy of this chart in a memo from the Director dated January 18, 2000.

Example:

Hank and his 2 children received TANF financial assistance in NH from October 1996 through January 1997 (4 months). The family moved to Rhode Island and received assistance in RI from February 1997 through September 1997. In October the family returned to NH and reapplied for assistance. RI’s start date for TANF is 5/1/97. Therefore, the months that are counted for Hank’s receipt of TANF assistance in RI are 5/1/97 through 9/97, or 5 months, despite Hank having actually received 8 months of financial assistance. The 5-month total is added to the 4 months Hank had previously earned in NH. As a result, Hank’s TANF clock is restarted in NH at month 10.

If Hank had moved back to NH and applied for assistance in April 1997, 0 months of assistance in RI would have been counted in NH because RI’s start date for TANF grants begins after April 1997. In this instance, Hank’s TANF clock would have been restarted in NH at month 5.

Out-of-State TANF Clock: Policy Clarifications to FAM 303.09

 FAM 303.09 was rewritten to emphasize that case technicians must verify months of TANF receipt in other states in order to get an accurate count of months of receipt to apply toward the 60-month lifetime limit.

 Text was added to clarify that the 60 months of receipt of TANF financial assistance includes receipt in any state, but that the counting of the 60 months begins as of the date on which a state’s TANF Program began, defined as the date on which the state’s TANF State Plan was effective. See the Example above.

Qualified Alien Status: Technical Corrections & Policy Clarifications to FAM 305

 Policy was corrected in FAM 305.01, 305.09, and 305.13 to state that only medical assistance is provided to certain American Indians regardless of whether they are qualified aliens per section 4(e) of the Indian Self-determination and Education Assistance Act [25 USC 450(e)] and section 289 of the Immigration and Nationality Act (8 USC 1359). Previously, policy was not clear on this issue, leading to the incorrect assumption that TANF financial assistance was also available to these individuals regardless of qualified alien status.

 FAM 305.17 was revised to indicate that certain qualified aliens may or may not be eligible for assistance if they entered the U.S. on or after 8/22/96, the date on which the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) was signed into law. Previous policy indicated that the "cut-off" date was 8/23/96.

Voluntary Quit: Clarifications to FAM 315 and 808

In an effort to enhance the logical flow and ease of access to voluntary quit policy, policy relating to voluntary quit, including the aspects of the sanctioning process unique to noncompliance due to voluntary quit, has been rewritten and reorganized in both FAM 315 and 808.

 Text previously in 808 that spoke specifically to voluntary quit prior to application has been removed from FAM 808 and relocated to FAM 315, including all policy related to the application of progressive sanctions for voluntary quit.

 Policy on reinstatement of financial assistance after compliance following a sanction has been rewritten for clarity and detail.

 Text has been added to clarify that for subsequent failures to comply which occur at any time within 6 months of the end of the most recent sanction period, even if the case is closed for all or part of the 6 month period, or the sanction was ended due to an exemption and the individual subsequently becomes mandatory, reduce the adjusted payment standard by the next highest payment standard reduction level. The same clarification has been made to FAM 808.35 (see below).

NHEP Work Program: Clarifications to FAM 808

Various sections of FAM 808 were revised to clarify existing policy:

 FAM 808.05: Text was added to this section to include permanent exemptions to participation in NHEP work programs, and the title of the section was revised by removing the word "Temporary."

 FAM 808.07: Text was added to this section to clarify that case technicians are responsible for determining exemption status based on acceptable documentation and verification of the exemption claim.

 FAM 808.31: Text was added to note the exception that in two parent families, either or both parents may comply with program requirements:

 if the family chooses to combine efforts to meet participation requirements, consider both parents to be mandatory; or

 if the family chooses to have only one parent meet participation requirements, consider that parent to be mandatory, and the other, non-participating parent, to be voluntary. If the non-participating parent wants to participate and have their hours in an approved NHEP activity count, change their status from voluntary to mandatory.

 FAM 808.35: In addition to the revisions to this section discussed above under Voluntary Quit, the following policy clarifications were made:

 Only one sanction for noncompliance may be applied to a two-parent case. If both parents are mandatory and not complying, apply the sanction to the casehead. If one parent is mandatory and the other parent is voluntary, apply the sanction to the mandatory parent.

 Policy that requires progression to the next sanction level for subsequent acts of noncompliance within 6 months of the end of a previous sanction period applies even if the case closed for all or part of the 6 month period or the individual became exempt while under sanction but his or her status changed to mandatory within the 6 month period.

 Sanctions must not be applied to a noncompliant individual if he or she meets NHEP exemption criteria at the time the sanction would normally begin.

 Individuals who become exempt from NHEP work program requirements while under sanction must have the sanction removed, and the payment standard returned to the pre-sanction level, in the next available payroll period, but no later than the payment period following the payment period in which the verification was provided.

 If that individual’s status later changes from exempt to mandatory, and there is a subsequent act of noncompliance without good cause, begin progressive sanctioning at level 1 regardless of the level of sanction at the time of the exemption unless the subsequent act of noncompliance occurs within 6 months of the end of the previous sanction period.

 FAM 808.37: Policy on Compliance Requirements for Two Parent Families has been substantially rewritten for clarity and accuracy. The clarifications include:

 re-emphasizing that two parent families have an hourly participation requirement which may be met either by one parent or by both parents in combination,

 that both parents are considered to be participating regardless of whether one or both are actually engaged in activities, and

 that two parent families have no temporary exemptions from participation since the participation requirements may be met by the participation of one or both parents.

/MìNEW FORMS

This section discusses new forms developed for the implementation of the family/domestic violence policy released with this SR.

Forms 243 and 243i

Form 243, Maybe There Is Help, is a client pamphlet used to inform TANF financial assistance clients and other interested parties about the TANF services available to victims of family/domestic violence. The pamphlet contains general information about:

 TANF support services and requirements;

 TANF waivers and special considerations available for victims;

 other TANF services available;

 descriptions of the various family/domestic violence support personnel available to aid victims;

 crisis center services; and

 the cycle of family/domestic violence.

Form 243 must be provided to all clients at the TANF initial eligibility interviews and redeterminations, NHEP orientations and assessments, or whenever it is requested, and should be used as the basis of discussion of TANF participation requirements, family/domestic violence, and available support services.

FORMS 754C AND 754CI

Form 754C, Request for TANF Family/Domestic Violence Option, is a 3-part NCR form used for the following purposes:

 as the client’s request for the Family Violence Options;

 as the client’s written statement for all requests due to family/domestic violence confirming the violence, if the client has exhausted all avenues of obtaining the specified documentation;

 to notify the client of the documentation required to corroborate a family/domestic violence claim and the time frame in which documentation must be provided;

 to provide the client the opportunity to request family/domestic violence services immediately; and

 to notify the client that the DHHS and NHEP staff are required by law to report any suspected abuse of children or elderly or handicapped adults in the household to the Division of Children, Youth, and Families (DCYF) and/or the Division of Elderly and Adult Services (DEAS).

Form 754C is completed under the following circumstances:

 When a TANF applicant or recipient reveals to the Case Technician that their family includes a member who is, or has been, a victim of family/domestic violence and the client is requesting a waiver of any of the following TANF-related program requirements:

 interstate migration 12 month waiting period;

 cooperation with child support requirements; or

 the 60-month lifetime limit.

 When an NHEP participant reveals to the NHEP team member or the Case Technician that their family includes a member who is, or has been, a victim of family/domestic violence and is requesting special considerations within the NHEP.

IMPORTANT — CAUTION

FORM 754C MUST ONLY BE PROVIDED TO THE CLIENT IN A FACE-TO-FACE MEETING. UNDER NO CIRCUMSTANCES IS FORM 754C TO BE MAILED TO THE CLIENT’S HOME.

Revised Forms

Form 77a

Revisions made to client pamphlet Form 77a include adding text about services and waivers provided to victims of family/domestic violence and text emphasizing the 60-month lifetime limit on receipt of financial assistance.

Form 221

Revisions were made to client pamphlet Form 221 to provide information about the special considerations given to victims of family/domestic violence in the NHEP program and to emphasize the 60-month lifetime limit on receipt of financial assistance.

Form 242

Revisions were made to client pamphlet Form 242 to clarify policy regarding the 60-month lifetime limit on receipt of financial assistance and to supply information about the special considerations and services provided to victims of family/domestic violence.

FORM 754A

Revisions were made to client pamphlet Form 754A to include the added acceptable reason of family/domestic violence to the good cause reasons for non-cooperation with child support requirements. The section on verification was also expanded to include the provision that a victim of family/domestic violence may provide a signed written statement confirming the abuse if the specified documentation is unobtainable.

FORM 754B

Form 754B was extensively revised to include the documentation component of the verification process for each good cause reason for non-compliance with child support requirements. Family/domestic violence was also added to the list of good cause reasons. In addition, obsolete references to former organizational structures were deleted or revised.

FORM 780

Revisions were made to Form 780 to add family/domestic violence to the list of reasons for a good cause claim for non-cooperation with child support requirements. Obsolete references to "Office of Child Support Enforcement Services" (OCSES) and "Assistant Chief, OCSES" were replaced with "Division of Child Support Services" (DCSS) and "DCSS Supervisor." A reason space was added for denied claims. The instructions were also clarified to remove the "Chief of the Bureau of Financial Planning" as a recipient of the copy of the form as statistics are compiled at DCSS on their computer system.

FORM 781

Revisions were made to Form 781 to expand upon its current use as written notification to clients regarding good cause claims for non-cooperation with child support requirements. Text was added regarding the 60-month lifetime limit and special considerations within the NHEP work program to provide clients with a written decision regarding their Family Violence Option requests as well as their requests regarding non-cooperation with child support requirements. Obsolete information regarding sanctioning procedures was removed. The form’s name was also changed from Good Cause Claim Decision, to Good Cause Claim/FVO Decision, to capture the expanded role of the form.

The instructions for all of the above forms were also reformatted and revised as necessary to reflect new policy.

FORMS DISTRIBUTION

 Until District Offices receive an initial supply of revised Forms 77a, 221, 242, 754A, 754B, 780, and 781, continue using the existing forms while informing clients of the policy changes at TANF initial eligibility interviews and redeterminations, and NHEP orientations and assessments.

 For immediate use, all District Offices will be provided with a photocopied supply of new Forms 243 and 754C at the training on February 9, 2000. This initial supply may be copied as necessary until the printed pamphlet and form become available.

 New Form 243 has a space available for the local Crisis Center to stamp their address and crisis line number or to staple their business cards. The family/domestic violence specialist will stamp these pamphlets as needed, when requested by the District Office.

IMPLEMENTATION

New policy released by this SR is retroactively effective to February 1, 2000. Upon receipt of this SR, begin informing all TANF applicants and recipients about the Family Violence Options at the initial eligibility interviews, redeterminations, and at the client’s request.

CLIENT NOTIFICATION

Client notification will occur at initial eligibility interviews via the information provided in the white packets given out at application. Additional information on the Family Violence Options will be provided at redeterminations and NHEP orientations and assessments.

/‘bTraining for DFA Supervisors was conducted on February 9, 2000. Case Technicians will also receive training on the family/domestic violence policy in the future. In addition to training on the policies released by this SR, attendees were given specific procedures to use with clients who request immediate assistance with family/domestic violence situations. Further training will be provided on an as needed basis.

POSTING INSTRUCTIONS

DISPOSITION

It is strongly recommended that this SR be retained for reference during the evolving process of implementing the family/domestic violence policy.

DISTRIBUTION

This SR will be distributed according to the electronic distribution list for Division of Family Assistance policy releases. This SR, and revised On-Line Manuals, will be available for agency staff in the On-Line Manual Library, and for public access on the Internet at http://www.dhhs.state.nh.us/PMIndex.htm, effective April 1, 2000.

This SR, and printed pages with posting instructions, will be distributed under separate cover to all hard copy holders of the Family Assistance and Forms Manuals.

DFA/JBV:s

------------------------------------------------------------------------------------------------------------------CERTIFICATE OF DESTRUCTION

I hereby certify that all copies of Forms 77a, SR 97-13/May 1997; 221, SR 98-51/December 1998; 242, SR 98-7/January 1998; 754A, SR 97-40/September 1997; 754B, SR 79-91/June 1979; 780, SR 79-91/June 1979; and 781, SR 79-91/June 1979; have been destroyed or recycled upon receipt of Forms 77a, 221, 242, 754A, 754B, 780, and 781 dated 02/00/SR 00-08.

Office Manager: _____________________ District Office: ______________________ 

Please return this to Stock Control, 6 Hazen Drive, upon receipt of revised forms.