SR 14-33 Dated 08/14

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR releases revisions to the following forms and their associated Spanish and Nepali versions to respond to certain US Department of Agriculture (USDA) Food and Nutrition Services (FNS) findings:

·      DFA Form 800, Application for Assistance;

·      DFA Form 811R: Application: Your Rights and Responsibilities; and

·      DFA Form 811S: Application: Statements of Understanding.

Additionally, this SR releases:

·      Unrelated revisions to client informational text associated with the use of a recipient’s EBT cash benefit at prohibited establishments (See DFA SR 14-05, dated 01/14 for more information about this policy). Changes to this text impacted a “statement of understanding” that is located in three places: on DFA Form 811S, in the New HEIGHTS eligibility interview summary (EIS), and in NH EASY. The text change also impacted the open Notice of Decision (NOD) for cash assistance recipients who have opted for EBT as their cash benefit issuance method; and

·      The unrelated obsolescence of DFA Form 811, Interview Worksheet, and its associated instructions because, as confirmed by the Division of Client Services (DCS) Field Operations Regional Managers, this form is no longer used.

DESCRIPTION OF REVISIONS MADE TO FORMS

DFA Form 800, Application for Assistance, is now a nine-page form (four back-to-back sheets plus a new insert page) containing 4 parts:

·      Information related to the application for DFA programs and services and the actual application questions, which is pages 1-4 of DFA Form 800 (two back-to-back sheets);

·      the rights and responsibilities section which must be provided at application. This we call DFA Form 811R, Application: Your Rights and Responsibilities, and is pages 5-6 of DFA Form 800 (one back to back sheet);

·      the statements of understanding section which we also provide at application. This we call DFA Form 811S, Application: Statements of Understanding, and is pages 7-8 of DFA Form 800 (one back to back sheet); and

·      the new non-discrimination notice. This new section, which will now be included in DFA Form 800 as an insert, used to be part of the Rights and Responsibilities section of the application. However, FNS changed the text that must be used to describe the various prohibitions against discrimination in all its various forms and guises, and the text that is now required by FNS fills an entire page. Due to printing restrictions, this extra page has to be included as an insert with DFA Form 800, and will no longer be part of DFA Form 811R.

DFA Form 811R and DFA Form 811S are also individual forms that are provided separately from DFA Form 800 to applicants and recipients, per policy. For example, DFA Form 811R is provided with every redetermination application to ensure that recipients are regularly provided with their Rights and Responsibilities.

Changes to DFA Form 800, Application for Assistance

·      The following statement, We will accept your Application even if you only fill in your name, address, and signature, was altered to read as follows to address FNS findings based upon 7 CFR 273.2(b)(1)(v): You have the right to immediately file your Application as long as it contains the applicant’s name and address and the signature of a responsible household member or the household’s authorized representative.

·      Changes were made to group eligibility questions in separate sections to address FNS findings based upon 7 CFR 273.2(b)(1)(ix), so that those questions that are needed to determine eligibility for Food Stamps and other DFA programs are located in Section H, and the remaining eligibility questions that apply to eligibility for other DFA programs but have no bearing on Food Stamp eligibility are listed in new Section I. The questions listed in Section I do not need to be completed by individuals who only wish to apply for Food Stamp benefits. Additionally, the following statement was added to the first paragraph of page 1 of DFA Form 800: If you only want Food Stamp benefits and are completing the full Application, please complete every Section except Section I.

·      The following new text was added under the header “Food Stamp (FS) Benefits” on page 1 of DFA Form 800, to address FNS findings based upon 7 CFR 273.2(c)(1) (italicized text delineates new text): Your FS benefits are based on the date of application, which is the date your completed application is received by the District Office. If you are a resident of an institution who is jointly applying for SSI and Food Stamp benefits prior to leaving the institution, the filing date of your application is your date of release from the institution.

·      The following new text was added under the header “Citizenship and Identity” on page 2 of DFA Form 800, to more closely align with 7 CFR 273.2(b)(2). This specific change is not related to an FNS finding (italicized text delineates new text): USCIS documentation will be verified and non-citizen status of applicant household members will be subject to verification through the submission of information from the application to USCIS, and the submitted information received from USCIS may affect eligibility and benefits.

·      FNS noted the absence of the following topics used to determine eligibility for Food Stamp benefits from NH’s application. Although these topics are not required to be a part of the application if NH explains the method of collecting the information, space allowed their inclusion on the application. In Section G of the application, entitled “Your Expenses”:

-     A field to collect “cost of doing business” was added for self-employed applicants; and

-     The following yes/no question was added to the household expenses section: Have you gotten more than $20 in fuel assistance in this or the past 12 months? See DFA SR 14-26, dated 3/10/14, for more information about new Food Stamp Program rules related to applying for the Low-Income Home Energy Assistance Program (LIHEAP).

·      To address FNS findings based upon the Food and Nutrition Act of 2008 (FNA), as amended through PL 110-246, Section 6(b)(1) [7 USC 2015], the phrase “buying or selling” was replaced with the word “trading” and the phrase “illegal drugs or certain prescription drugs” was replaced with the phrase “controlled substance” under the Trafficking Food Stamp Benefits header of DFA Form 811R.

·      To address FNS findings based upon 7 CFR 273.16(d), the following new text was added in bold lettering under the Intentional False Statements or Program Violations (IPV) header of DFA Form 811R (italicized text delineates new text): Anyone who commits an intentional program violation (IPV) in the Food Stamp Program cannot get these benefits for 12 months for the 1st violation, 24 months for the 2nd violation, and permanently for a 3rd IPV.

·      The following new text was added under the Medical Assistance header of DFA Form 811S, per the requirements of RSA 126-A:5,XXVI associated with the NH Health Protection Program (NHHPP/NHHPP-M) [see DFA SR 14-28, dated August 2014, for more information] (italicized text delineates new text): I understand that my receipt of medical assistance under the NH Health Protection Program requires me to contact NH Employment Security for the purpose of finding employment if I am unemployed. This specific change is not related to an FNS finding.

·      The following revision unrelated to an FNS finding was made to DFA Form 811S, to better reflect implementation of the EBT cash usage policy released in SR 14-05, dated 01/14 (red/strikethrough indicates deleted text and bold/blue indicates added text):

I understand that my EBT card or cash from my EBT card cannot be used at liquor stores in which more than 50% of visible inventory is alcohol, gaming establishments, or businesses which provide in which more than 50% of visible inventory being sold or rented is material considered adult-oriented entertainment per RSA 650:1,III, and that if I use my EBT card or cash from my EBT card at one of these places, I will be sanctioned with a cash penalty, per RSA 167:7-b and He-W PART 608.

The Spanish and Nepali translations of DFA Forms 800, 811R, and 811S will be updated accordingly. Since there are no changes associated with the use of these forms, their associated instructions did not require revisions and will not be re-released with this SR.

The current English version of these forms must be used until the supply is exhausted, at which point the new versions will be printed. The English version of these forms are available in the DHHS Warehouse and can be ordered using current forms reordering procedures, via the Quarterly Forms Order (QFO). The Spanish and Nepali translation can be reordered by contacting the Supervisor of the Policy Development Unit. The forms are also available electronically, for Department staff only, on the Lotus Notes Family Services Database and on the website at. http://www.dhhs.nh.gov/dfa/apply.htm and http://www.dhhs.nh.gov/dfa/forms.htm.

FNS Findings That Were Not Addressed Via Changes to DFA Form 800

According to FNS:

·      NH was cited as out of compliance with 7 CFR 273.2(b)(1)(iv) because NH’s application, DFA Form 800, did not contain “…A place on the front page of the application where the applicant can write his/her …signature.” In NH, a field for the applicant’s signature is located on the back of the front page of the application. NH’s Food Stamp Program Specialist requested and subsequently received approval for a waiver of this FNS requirement and confirmed that no changes were needed to the application to address this specific finding.

·      NH was cited as out of compliance with section 115 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), in which Food Stamp benefits are disallowed for individuals with a drug-related conviction. NH did not make any changes to the application or application process to respond to this finding because NH has opted out of this mandate via RSA 167:81-a, as permitted by 7 CFR 273.11(m).

·      NH was cited as out of compliance with 7 CFR 273.2(g) because NH’s application does not explain to applicants the application processing timeframes. Although NH does not agree that the citation listed requires NH to have this information on the application or an addendum to the application as FNS maintains in their finding, NH does indeed have information about application processing timeframes on an addendum to the application, specifically DFA Form 800A, DFA Programs & Services Guide. Therefore no changes were made to address this finding.

·      NH was cited as not having the following information located on NH’s application, and this information must be collected for Food Stamp eligibility determinations. If not collected through the application, a method must be in place to otherwise collect this information:

-     First, last, and middle initial of all household members. FNS was correct that NH did not specifically request the middle initial of any applicant or applicant household member on the paper application. Although NH could not locate any FNS mandate requiring the collection of a middle initial of an applicant or applicant household member’s name, and FNS did not supply a citation to support this finding, the application was edited to request the “Full Legal Name” of each applicant and household member (italicized text denotes added text) to address this concern.

-     If anyone was a boarder or foster child/adult. The NH Food Stamp Program Specialist confirmed that no changes were needed to the paper or electronic application to address this FNS concern and NH’s method of collecting this information would be explained to FNS.

-     Any member on strike. The NH Food Stamp Program Specialist confirmed that no changes were needed to the paper or electronic application to address this FNS concern and NH’s method of collecting this information would be explained to FNS.

-     Any member disabled [missing on the e-application only]. The New HEIGHTS Administrator confirmed that the e-application (NH EASY) does ask about applicant disability; the NH Food Stamp Program Specialist confirmed that no changes are needed to address this FNS concern and this situation will be explained to FNS.

-     Student between ages 18-49. The paper and e-application both ask for date of birth and whether each household member is a student. The NH Food Stamp Program Specialist confirmed that no changes are needed to address this FNS concern and this situation will be explained to FNS.

-     If student, class hours. The NH Food Stamp Program Specialist confirmed that no changes were needed to the paper or electronic application to address this FNS concern and NH’s method of collecting this information would be explained to FNS.

-     If student, income/educational expenses. The NH Food Stamp Program Specialist confirmed that no changes were needed to the paper or electronic application to address this FNS concern and NH’s method of collecting this information would be explained to FNS.

-     Resources jointly owned with non-household member. The e-application does collect this information but the NH Food Stamp Program Specialist confirmed that no changes were needed to the paper application to address this FNS concern and NH’s method of collecting this information would be explained to FNS.

-     Self-employment income. There are places on the application to enter this information and this information is collected in the e-application. The NH Food Stamp Program Specialist confirmed that no changes were needed to the paper application to address this FNS concern and NH’s method of collecting this information would be explained to FNS.

-     Outside help with payments. The NH Food Stamp Program Specialist confirmed that no changes were needed to the paper application to address this FNS concern and NH’s method of collecting this information would be explained to FNS.

Obsoletion of DFA Form 811, Interview Worksheet, and its associated instructions

Due to lack of use and after discussions with DCS Field Operations Regional Managers, DFA Form 811, Interview Worksheet, and its associated instructions, DFA Form 811(i), are obsolete effective with the date of this SR. Recycle all copies still available in the District Offices accordingly.

NEW HEIGHTS SYSTEMS PROCEDURES AND IMPLEMENTATION

Updates to New HEIGHTS and NH EASY to reflect NH’s response to the FNS findings are scheduled for release on August 29, 2014.

The statements of understanding text changes that were made to DFA Form 811S will be implemented in the New HEIGHTS and NH EASY systems as follows:

·      NH EASY will be updated with the new text on August 29, when the FNS related text changes mentioned above are made.

·      EIS in New HEIGHTS will be updated in October during the EIS’ conversion to JAVA.

Additionally, text about the EBT cash usage policy currently populated on NODs generated during a case opening for cash assistance in which the benefit issuance method chosen is EBT has been revised as follows effective Friday, August 8, 2014 (red/strikethrough indicates deleted text and bold/blue indicates added text):

Important Information About Using Your EBT Card

Do not use your EBT card or cash from your EBT card at liquor stores in which more than 50% of visible inventory is alcohol, gaming establishments, or businesses which provide in which more than 50% of visible inventory being sold or rented is material considered adult-oriented entertainment per RSA 650:1,IIIin which performers disrobe or perform in an unclothed state for entertainment. If you use your EBT card or cash from your EBT card at one of these places, you will be sanctioned with a cash penalty, per RSA 167:7-b and He-W PART 608. The best use of your cash grant is to help pay for things you need to support you and your family, such as for rent or mortgage payments, utility bills, gas, child care, or laundry.

POLICY MANUAL REVISIONS

Revised Food Stamp Manual Topics

Section 101.01   Individual Rights

PART 103   NONDISCRIMINATION

PART 109   APPLICATION PROCESS

Section 109.01   Filing an Application

Section 713.03   Disqualification Periods

IMPLEMENTATION

The paper form changes released in this SR are effective as of August 1, 2014, but the forms will not be printed with the changes released in this SR until the current supply has been exhausted. The corresponding changes that were made in New HEIGHTS and NH EASY will be available according to the timelines described in the NEW HEIGHTS SYSTEMS PROCEDURES AND IMPLEMENTATION section above.

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 September 29, 2014. Additionally, this SR, and printed pages with posting instructions, will be distributed under separate cover to all internal hard copy holders of the Food Stamp and Forms Manuals.

DFA/JBV:s