SR 14-12 Dated 03/14

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR releases revisions to the following New Hampshire Employment Program (NHEP) forms, their associated instructions, and their associated Spanish translations:

·      Form NHEP228(O), NHEP Employability Plan (Orientation Version);

·      Form NHEP266, NHEP Education/Training Activities Verification Form; and

·      Form NHEP267, Job Readiness Activity Verification Form.

In a related change, Form NHEP231, NHEP Participation Agreement, and its associated instructions, Form NHEP231(i), are obsolete with the release of this SR, as the contents of Form NHEP231 have been incorporated into Form NHEP228(O).

This SR also releases unrelated revisions to DFA Form 221, NHEP Pamphlet, and DFA Form 221(Sp), Spanish Version of DFA Form 221, to clarify text related to who is exempt from NHEP work requirements. Additionally, DFA Form 221(Bo), Bosnian Version of DFA Form 221, is obsolete as of the release of this SR.

This SR also releases an unrelated policy clarification related to Job Club as an NHEP activity. Formerly Job Club was linked to the Community Work Experience Program (CWEP) and listed in policy as such. Job Club is now included as a Job Search activity.

DESCRIPTION OF REVISIONS MADE TO FORMS

Form NHEP228(O)

Form NHEP228(O), NHEP Employability Plan (Orientation Version), is a one-page, double-sided form in which both pages of the form are a two-part no-carbon-required (NCR) form. Both pages of Form NHEP228(O) must be completed and signed by all FANF applicants that are referred to an NHEP orientation. Form NHEP228(O) serves as an agreement of participation in NHEP between NHEP participants and staff, outlines the requirements an individual must meet while participating in NHEP, outlines what assistance the Employment Counselor Specialist (ECS) will provide to help the NHEP participant meet the NHEP participation requirements; and informs mandatory NHEP participants that less than full compliance with NHEP requirements will result in the individual’s FANF grant and Childcare Assistance being reduced or closed.

The following revisions have been made to Form NHEP228(O) at the request of the NHEP administrator and NHEP Team Members:

·      This form is now two pages in which both pages are a two-part NCR. Because there is no NCR paper that allows one document to be a 2-part NCR for both pages, and because NHEP has indicated that both pages must be NCR, it means that the new form will be printed as 2 separate forms: a 2-part NCR for page 1 of Form NHEP228(O) and a 2-part NCR for page 2 of Form NHEP228(O). Note: It is the NHEP Team Member’s responsibility to ensure that both pages are available for NHEP Orientations prior to the Orientations being scheduled.

·      Addition of a new text box notifying NHEP participants that once they receive notice that their NHEP cash assistance is approved, they will be immediately responsible for providing verification that they are meeting NHEP requirements in an approved work activity.

·      Addition of a space to provide the age of the NHEP participant’s youngest child, and check boxes to indicate if the NHEP participant is required to participant for 20 or 30 hours each week.

·      Addition of check boxes for NHEP participants to agree to the next steps they will need to take after they have attended orientation and their NHEP cash assistance is approved.

·      Addition of check boxes for NHEP participants to indicate possible reasons why they will not be able to participate in NHEP work activities.

·      Addition of check boxes for the NHEP participant to agree to stay and talk to a Child Care Resource and Referral representative or ECS if they have a barrier to participating in NHEP, such as child care, transportation, housing, or another barrier. Additionally the forms in which NHEP participants must record their efforts to resolve these barriers are identified.

·      Addition of text to clarify NHEP participants must begin work activities once their NHEP cash assistance is open, rather than once NHEP participants leave orientation.

·      Addition of the agreement that NHEP participants understand that information about their case may be shared with contracted agencies who provide NHEP work activities and services.

·      Revisions to text to bring the reading level down from a 12.7 grade level to closer to an 8th grade level.

Instructions for Form NHEP228(O) were revised accordingly. The current version of Form NHEP228(O) must be used until the supply is exhausted, at which point the new version will be printed. The English version of Form NHEP228(O) is available in the DHHS Warehouse and can be ordered using current forms reordering procedures, via the Quarterly Forms Order (QFO). The Spanish version of the form can be ordered by contacting the Supervisor of the Policy Development Unit, as needed. Both forms are also available electronically, for Department staff only, on the Lotus Notes Family Services Database.

Form NHEP266

Form NHEP266, NHEP Education/Training Activities Verification Form, is a one-page, single-sided form used by NHEP participants to verify weekly participation in education and training activities. This form is distributed and reviewed by the ECS. Education and training are daily-supervised activities that must be verified on a weekly basis. Reviewing this form, along with ongoing assessments of the individual, assist the ECS in determining if the individual is complying with their Employability Plan.

The following revisions have been made to Form NHEP266 at the request of the NHEP administrator and NHEP Team Members:

·      Addition of text notifying the NHEP participant that an ECS must have received information from the school regarding the NHEP participant’s education/training program, and approve the NHEP participant for the education/training activity, prior to the NHEP participant receiving credit for this activity as a countable work activity for NHEP work program participation hours.

·      Instructions on how the NHEP participant must complete the form were clarified, and additional instructions were added.

·      To simplify the form, the section in which the NHEP participant obtains the instructor’s signature was moved to align with the section in which the NHEP participant fills in the class name and days attended.

·      The section to indicate hours the NHEP participant was absent from the education/training activity was eliminated from the form.

·      A field for the instructor’s contact information was added.

·      Examples of how to enter acceptable supervised study hours was added to the form.

·      A field for the ECS to provide an approval signature was added.

·      The text was further edited to bring the reading level down from an 8.6 grade level to a 7.8 grade level.

Instructions for Form NHEP266 were revised accordingly. The current version of Form NHEP266 must be used until the supply is exhausted, at which point the new version will be printed. The English version of Form NHEP266 is available in the DHHS Warehouse and can be ordered using current forms reordering procedures, via the QFO. The Spanish version of the form can be ordered by contacting the Supervisor of the Policy Development Unit, as needed. Both forms are also available electronically, for Department staff only, on the Lotus Notes Family Services Database, and on the DHHS website at www.dhhs.nh.gov/dfa/tanf/employment.htm.

Form NHEP267

Form NHEP267, Job Readiness Activity Verification Form, is a one-page, single-sided form used by NHEP participants enrolled in the job readiness activity. It is used to track the time the participant spends completing Form NHEP225, NHEP Planning for Success: Job Readiness Portfolio. This form is distributed and reviewed by the ECS. The job readiness activity of the client portfolio is an activity that must be verified on a bi-weekly basis. The ECS must evaluate the individual’s progress in their job readiness efforts. Reviewing this form, along with ongoing assessments of the individual, assist the ECS in determining if the individual is complying with their Employability Plan.

The following revisions have been made to Form NHEP267 at the request of the NHEP administrator and NHEP Team Members:

·      The Portfolio Hotline number was removed from the form as it is no longer in existence.

·      Two more columns were added for the NHEP participant to record time spent completing portfolio sections.

·      Text was revised to bring the reading level down from an 11.6 grade level to closer to an 8th grade reading level.

Instructions for Form NHEP267 were revised accordingly. The current version of Form NHEP267 must be used until the supply is exhausted, at which point the new version will be printed. The English version of Form NHEP267 is available in the DHHS Warehouse and can be ordered using current forms reordering procedures, via the QFO. The Spanish version of the form can be ordered by contacting the Supervisor of the Policy Development Unit, as needed. The forms are also available electronically, for Department staff only, on the Lotus Notes Family Services Database, and on the DHHS website at www.dhhs.nh.gov/dfa/tanf/employment.htm.

Form NHEP231

In a related change, Form NHEP231, NHEP Participation Agreement, and its associated instructions, Form NHEP231(i), are obsolete with the release of this SR, as the contents of Form NHEP231 have been incorporated into Form NHEP228(O). A Certificate of Destruction has been included with this SR.

UNRELATED CLARIFICATIONS

Unrelated revisions have been made to DFA Form 221, NHEP Pamphlet, and its Spanish translation, DFA Form 221(Sp) to:

·      clarify text related to who is exempt from New Hampshire Employment Program (NHEP) work requirements [bold text denotes added text, and text with strike through denotes eliminated text]:

…you are a dependent child age 16 or older who is a and in school full-time student in elementary, secondary, vocational/technical school, or the equivalent; and

·      replace “GED” so that text reads as follows [bold text denotes added text, and text with strike through denotes eliminated text]: high school diploma or GEDits equivalency.

Instructions were revised accordingly. The current English and Spanish versions of this form must be used until the supply is exhausted, at which point the new versions will be printed. The English version of DFA Form 221 is available in the DHHS Warehouse and can be ordered using current forms reordering procedures, via the QFO. The Spanish version of the form can be ordered by contacting the Supervisor of the Policy Development Unit, as needed. Both forms are also available electronically, for Department staff only, on the Lotus Notes Family Services Database as well as on the following DHHS website: http://www.dhhs.nh.gov/dfa/publications.htm.

DFA Form 221(Bo), Bosnian Version of DFA Form 221, is obsolete upon the release of this SR. The Office of Minority Health and Refugee Affairs (OMHRA) has informed DFA that the Bosnian population in NH has greatly diminished. Because of this, OMHRA indicated that there is no longer a need for DFA forms to be translated into Bosnian. As such, DFA Form 221(Bo) will not be updated with the changes made to the English version but instead is obsolete. A Certificate of Destruction has been included with this SR.

UNRELATED POLICY CLARIFICATION

Job Club is an NHEP Job Search activity, which is administered by local community organizations. Job Club helps prepare NHEP participants to seek employment. Formerly, Job Club was listed in policy as a CWEP activity. Job Club is now listed in policy as a Job Search activity.

POLICY MANUAL REVISIONS

Revised Family Assistance Manual Topics

Section 808.27  Hourly Participation Requirements

Section 808.39  NHEP Activities: Job Club

Section 808.39  NHEP Activities: Job Search

IMPLEMENTATION

The policy released in this SR is effective upon release.

The current version of DFA Form 221, Form NHEP228(O), Form NHEP266, and Form NHEP267 must be used until the supply is exhausted, at which point the new versions will be printed. The English versions of all forms are available in the DHHS Warehouse and can be ordered using current forms reordering procedures, via the QFO. The Spanish versions of the forms, if the form has been translated, can be ordered by contacting the Supervisor of the Policy Development Unit, as needed. These forms are also available electronically, for Department staff only, on the Lotus Notes Family Services Database.

CLIENT NOTIFICATION

No special client notification is planned.

TRAINING

No special training is planned.

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 www.dhhs.nh.gov/DFA/publications.htm, effective April 28, 2014. Additionally, this SR, and printed pages with posting instructions, will be distributed under separate cover to all internal hard copy holders of the Family Assistance Manual and Forms Manual.

DFA/LRB:s