SR 09-22 Dated 07/09

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR releases several new and revised forms used with the Financial Assistance to Needy Families (FANF) program and New Hampshire Employment Program (NHEP):

§   new Form NHEP267, Job Readiness Activity Verification Form, and its associated instructions, brought back from obsoletion;

§   new Form NHEP275, Distance Learning Activity Log, and its associated instructions;

§   new Form 720, Determination of Incapacity Status, and its associated instructions; and

§   revisions to the following FANF or NHEP forms:

-   Form NHEP223, NHEP Employer Contact Log, and its associated instructions;

-   Form NHEP225, NHEP Planning for Success Job Readiness Portfolio, and its associated instructions;

-   Form 261, Financial Assistance to Needy Families Interview Checklist;

-   Form NHEP266, NHEP Education/Training Activities Verification Form, and its associated instructions; and

-   Form NHEP270, Work Experience Program (WEP) Verification Form.

DESCRIPTION OF REVISIONS MADE TO FORMS

New Forms

Form NHEP267, Job Readiness Activity Verification Form, previously called Portfolio Assignment and Verification Form, has been brought back from obsoletion and slightly revised to align with the revisions made to the Form NHEP225, NHEP Planning for Success: Job Readiness Portfolio, also released in this SR. In October 2006, when the Form NHEP267 was obsoleted, more restrictive regulations had just been enacted related to monitoring independent work efforts by NHEP participants. These more restrictive regulations made it impossible to count an NHEP participant’s independent work on the portfolio towards work participation requirements; the participant’s independent work on the portfolio could only be counted towards compliance efforts. However, final TANF regulations that became effective in October 2008 clarified the definition of supervision in regards to job readiness activities. "Supervision" was defined as "oversight and responsibility," not daily in-person contact. As such, NH is using this form to supervise the participant’s job readiness activities, including work in the portfolio, which can now count towards work participation requirements.

This one page, single-sided form collects the time the NHEP participant spends on a bi-weekly basis in approved job readiness activities, including work on the NHEP portfolio. Instructions for this form were created accordingly, and the form is now available for use in all NHEP offices.

New Form NHEP275, NHEP Distance Learning Activity Log, was created to incorporate final TANF regulations that became effective in October 2008 in which restrictions on the methods of instruction that could be used as a work activity, and therefore count towards NHEP work participation requirements, were loosened. In the final regulations, states were encouraged to find ways to utilize distance learning activities, such as web-based classes or trainings, with NHEP participants. However, previously mandated verification requirements for all NHEP activities still needed to be met, so a standardized form, the Form NHEP275, was created to track this type of activity and verify the NHEP participant’s time spent in the activity.

This one page, single-sided form collects the time the NHEP participant spends on a weekly basis in activities associated with the participant’s enrollment in the distance learning activity. One log is submitted for each distance learning course taken, and evidence of the work completed during the week, or feedback from the program for the work completed during this time, must be attached to the log. Instructions for this form were created accordingly and the form is now available for use in all NHEP offices.

Form 720, Determination of Incapacity Status, was created to take the place of DDU Form 921, Determination of Incapacity Status. DDU Form 921 was previously used by two-parent families who were applying for FANF financial assistance via a deprivation reason of an incapacity lasting at least 30-days. DDU Form 921 contained incorrect information on the form as well as confusingly-written instructions to physicians, clinicians, and clients, but because it was not a DFA form, changes could not be made to it. As such, DFA has created new Form 720 to replace DDU Form 921. Although DFA cannot obsolete a non-DFA Form, DFA is obsoleting the use of this old DDU form when determining incapacity of a FANF parent. Effective with the release of this SR, new DFA Form 720 must be provided to clients instead of DDU Form 921. However, any DDU Form 921 still in circulation and submitted by clients, physicians, or clinicians must be accepted and acted upon according to current policy until the supply of the forms in circulation is exhausted.

New DFA Form 720 is a one page, double-sided form that is used in the same way that the former DDU Form 921 was used. New DFA Form 720:

§   authorizes the FANF applicant’s physician or psychologist to disclose protected health information to the Department of Health and Human Services, including contract staff; and

§   obtains documentation from a physician or psychologist for an individual claiming to be physically or mentally incapacitated to such a degree that the individual’s ability to support or care for his/her children is substantially reduced, and the incapacity is expected to last for a period of 30 continuous days from the application date, or lasted 30 continuous days in the 90 day period prior to the application date.

No other policy was changed related to the determination process for FANF-related incapacity. Instructions for this form were created accordingly and a small supply of the form was forwarded to every District Office prior to the release of this SR. The form is also now available for use in the DHHS Warehouse and can be ordered at the next quarterly forms order for the office.

Revised Forms

Form NHEP223, NHEP Employer Contact Log

Form NHEP223, NHEP Employer Contact Log, was revised to simplify the form, such as in the instructions provided to the client, but also reworded to better focus the client on specific employment activities and better capture the amount of time the participant spends in those activities. Much of the text on the form was removed and replaced with brief bulleted text explaining what the NHEP participant needs to do to complete the form. Participant name and RID fields were kept, as well as the week begin and end date fields, but the following fields were removed to simplify the form:

§   the NHEP worker’s name and phone number;

§   the date the verification is due to NHEP; and

§   the date the NHEP worker entered the hours from the log into New HEIGHTS.

Additionally, the table itself was revised as follows to better capture the participant’s activities:

§   The week begin day is now Saturday, instead of Sunday, and the week end day is Friday, instead of Saturday. This aligns the form’s presentation of information with the ACF week, which makes it easier to transfer the information from the form into New HEIGHTS;

§   In a previous version of this form, the Employer contact information header for one of the columns was expanded based on field worker request, to include the employer’s phone number, email, website, and fax contact information. In this version the column has been simplified back to just the employer phone number, again based on field worker request;

§   The "Type of Work" column header was replaced with "Position/Type of Work Looking for;"

§   the "Results" column header was renamed "Actions Taken (*see back)." On the back of the log, participants are now instructed to use phrases such as: "completed an application," "submitted a resume," "seen for an interview," "phone call," "sent an email," or "viewed website" to complete this column and describe their specific actions taken while in this activity;

§   the "Hours Worked" column was renamed "Time Spent for Each Action;" and

§   the "Miles Traveled" column was eliminated.

Additionally, a new table was added to the bottom of the first page of the form to capture the total hours spent per day on the participant’s job search for the week. The instructions for this form were revised accordingly and this form is now available for use by all NHEP offices.

Revised Form NHEP225, NHEP Planning for Success Job Readiness Portfolio

Form NHEP225, NHEP Planning for Success Job Readiness Portfolio, has been reworked to further simplify the language and refocus on the participant’s immediate employment needs and long-term goals used in the development of the Employability Plan. Participants can now complete work in the NHEP Portfolio and have it count towards work participation requirements via the use of Form NHEP267, discussed earlier in this SR. This latest version of the NHEP Portfolio consists of the following seven sections with a total of 66 double-sided pages, compared to the former five sections totaling approximately 64 pages:

§   Section A: Getting Ready, Assessing Your Skills, Interests, Abilities, & Needs;

§   Section B: Choosing Your Future, Exploring and Setting Career Goals;

§   Section C: Planning Your Job Search, Where to Look and What to Say;

§   Section D: Equipping Yourself for Success, Job Search Techniques and Tools;

§   Section E: Staying on Track, Tips for Balancing Work and Life;

§   Section F: Succeeding on the Job, Job Satisfaction and Career Advancement; and

§   Section G: Resources, Answer Sheets, Websites, Extra Forms, and More

Certain of the sections in the prior version of the Portfolio were reworked and renamed in the revisions process. However, the following sections were removed entirely from the revised version of the NHEP Portfolio:

§   Section A, Welcome to NHEP; this section was replaced with a one-page "About Us" overview instead;

§   Section D, Arranging for Child Care; and

§   Section E, Arranging for Transportation.

The instructions for this form were updated accordingly and the new version of the Portfolio will be available for use in all NHEP offices once the supply of the old version of the portfolio is gone. NHEP offices are to continue to use the old version of the portfolio until they are gone due to the costs associated with the creation of each book.

Revised Form 261, Financial Assistance to Needy Families Interview Checklist

In reviewing Form 261, Financial Assistance to Needy Families Interview Checklist, prior to reprinting, decisions were made to eliminate the discussion topics related to:

§   the Interim Disabled Parent (IDP) program and choice of program for this category of assistance, because the IDP program is currently not being offered to applicants;

§   reviewing Form 260, Financial Assistance to Needy Families Fact Sheet, with applicants as the Form 260 will be discontinued in a future project; and

§   going over the Form NHEP231, NHEP Participant Agreement, at the District Office. Per SR 08-23, dated October, 2008, this form is only provided at the NHEP orientation and is no longer provided during the eligibility interview.

Additionally, per SR 09-20, dated July 2009, the reference to DALR was removed from one of the topic categories, and replaced with "Form 752" and slight alterations were made to the titles of the Forms listed. See that SR for further information about the revised medical exemption process. No changes to the instructions for this form were required and the new version of Form 261 will be available for use in the District Offices once the supply of the old version has been exhausted. The new version of the form will not be printed until that time.

Revised Form NHEP266, NHEP Education/Training Activities Verification Form

Form NHEP266, NHEP Education/Training Activities Verification Form, has been streamlined to a singled-sided form from a double-sided form. The emphasis on providing the form every 2 weeks has been removed, but a greater emphasis has been placed on the supervised study hours. Additionally:

§   A new column has been added in which the instructor must indicate the required or advised number of outside study hours necessary for each class.

§   Instructions have been added on the form to indicate that the teacher or trainer for the activity must indicate on the form the time the NHEP participant spends in class and the time outside of class that is advised or required for the NHEP participant to study for the class. The participant, however, may count 1 hour of unsupervised homework or study time for each hour of actual class time and an additional field has been added to the form to collect this information.

§   Extra fields have also been added to collect time spent in a supervised study setting, which must be verified by the instructor.

§   New signature fields have been added to the form for classroom instructor signatures.

§   Rather than indicating that the NHEP participant is "making good and satisfactory progress" in the class, the authorized signature now indicates that the NHEP participant attended the session.

§   A new field was also added for the name of the institution and for the NHEP worker to indicate when the information on the Form NHEP266 was reviewed and entered into New HEIGHTS.

§   As with the other NHEP forms containing a week begin and end date, this form was revised to have the week begin day changed to Saturday from Sunday, and the week end day changed to Friday from Saturday.

The instructions for this form were revised accordingly and this form is now available for use by all NHEP offices.

Revised Form NHEP270, Work Experience Program (WEP) Verification Form

The only change made to Form NHEP270, Work Experience Program (WEP) Verification Form, was to replace the work begin and end days of Sunday and Saturday to Saturday and Friday, respectively. No other changes were made. The instructions for this form were not altered, as the usage of the form remained unchanged. This form is now available for use by all NHEP offices.

Revisions to all the NHEP forms identified above were in direct response to the kinds of information participants were providing on the current versions of the form and based exclusively on feedback from NHEP workers. The forms were tested in the field for a year and further revisions were made based on this usage and NHEP worker input.

POLICY MANUAL REVISIONS

Revised Family Assistance Manual Topics

Section 203.09  Interim Disabled Parent (IDP)

Section 209.13  Incapacity: Family Services Specialist (FSS) Determines Incapacity

Section 209.37  Verification of Deprivation

Section 808.15  Orientation

Section 808.17  Service Determination Appointment (SDA) and Ongoing Assessments

Section 808.29  Documenting and Verifying Hourly Participation Rates

Section 808.31  Compliance Requirements

Section 808.39  NHEP Activities: Basic Education

Section 808.39  NHEP Activities: English as a Second Language

Section 808.39  NHEP Activities: Job Readiness

Section 808.39  NHEP Activities: Job Search

Section 808.39  NHEP Activities: Post Secondary Education

Section 808.39  NHEP Activities: Single Course

Section 808.39  NHEP Activities: Vocational Educational Training

IMPLEMENTATION

The forms released in this SR can be used immediately upon receipt and as instructed in this SR. Reorder using the current forms ordering system for NHEP or District offices.

CLIENT NOTIFICATION

No special client notification was needed.

TRAINING

No special training was needed.

FORMS MANUAL POSTING INSTRUCTIONS

DISPOSITION

This SR may be destroyed or deleted after its contents have been noted and the revised manual topics released by this SR have been posted to the On-line manuals.

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.nh.gov/DHHS/DFA/LIBRARY, effective August 31, 2009. Additionally, this SR, and printed pages with posting instructions, will be distributed under separate cover to all internal hard copy holders of the Forms Manual.

DFA/JBV:s

** Due to the large size of the Form NHEP225, NHEP Planning for Success: Job Readiness Portfolio, the instructions only are attached to the SR. The form will be sent under separate cover to each office at a later date.