SR 15-15 Dated 06/15

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR releases changes in Emergency Assistance (EA) eligibility criteria, verification requirements, and qualifying expenses. As a result of these changes, the following forms were revised:

·      DFA Form 77R, Emergency Assistance (EA) for Housing: What You Need to Know, its Spanish and Nepali versions, DFA Forms 77R(Sp) and DFA Form 77R (Ne), and its instructions, DFA Form 77R(i); and

·      DFA Form 765, Application for Emergency Assistance, and its instructions.

Additionally, DFA Form 77R(Bo), Bosnian version of DFA 77R, is obsolete with the release of this SR.

The revisions to this policy address EA to secure or retain housing and utilities only, and do not address employment obstacle assistance available through the New Hampshire Employment Program.

POLICY

Families living in subsidized housing may now receive emergency assistance (EA) if they otherwise meet the eligibility requirements.

EA may be authorized for security deposits, or rent arrearages, or both as long as:

·      the total of both does not exceed $650; and

·      the assistance group’s monthly rental payment or security deposit amount does not exceed the total of their monthly income.

In addition to heat, electricity, and gas, EA may be used to pay for water and sewer deposits and arrearages. Utility deposits may be authorized for up to the amount charged by the provider.

EA may be authorized for home heating fuel arrearages, including arrearages accrued at a previous place of residence, when clearance of the arrearage will allow for a current fuel delivery at the current address. EA for past and current deliveries combined may not exceed $700 per year.

Example: In February, Peggy and her family received a delivery of home heating fuel from ABC Oil Company costing $500, which they did not pay. In March, Peggy’s family received another delivery of home heating fuel costing $300, which they also did not pay. ABC Oil Company refused to make another delivery unless payment was made. In April, Peggy submitted an EA application to pay for home heating fuel arrearages, plus $200 to secure a current fuel delivery. If Peggy can obtain verification from ABC Oil Company stating that payment of the $300 March fuel arrearage amount will allow for a current fuel delivery, the Family Services Specialist (FSS) may authorize $300 towards fuel arrearages. The FSS may not authorize payment for the February delivery costing $500, since it was not the most recent delivery. However, the FSS may authorize the requested payment of $200 for a current fuel delivery, since this amount added to the $300 arrearage would not exceed the $700 annual payment maximum for home heating fuel. Peggy would have $200 available to use over the next 12 months for another fuel delivery.

Example: Samuel and his family received a $500 home heating fuel delivery from ABC Oil Company while they lived on Parsons Street. Samuel was not able to pay for the fuel delivery. Shortly after, Samuel and his family moved to Green Street. To receive a home heating fuel delivery from ABC Oil Company at his Green Street residence, ABC Oil Company has verified that Samuel must first pay the $500 he owes from his Parsons Street address. Samuel applies for EA to cover the $500 he owes from his previous address, plus $200 to pay for a current fuel delivery at his current address. The FSS may authorize the EA payment if ABC Oil Company verifies that payment at the former address will allow a current fuel delivery at the current address. Because these amounts add up to the $700 per year maximum, Samuel is not eligible to receive EA for home heating fuel for 12 months from the date the $700 EA payment is authorized.

Example: Grace and her family received a $900 home heating fuel delivery from ACME Propane Company in January, of which they could only pay $100. In March, Grace submitted an EA application for $800 to help with the payment, including documentation that she applied for and was denied fuel assistance. Because Grace’s request exceeds the $700 12-month maximum that may be authorized for home heating fuel per year, Grace must provide the FSS with verification that payment will cure the emergency and allow for future fuel deliveries. Acceptable verification includes documentation that 1) ACME Propane Company will accept the $700 as full payment for the arrearage; 2) a payment plan for the remaining $100 has been arranged with ACME Propane Company; or 3) an outside source intends to pay the remaining $100. Once Grace provides this documentation, the FSS may authorize the EA payment for $700.

NEW HEIGHTS SYSTEMS PROCEDURES AND IMPLEMENTATION

New HEIGHTS is unable to automate changes released in this SR at this time. When they are able to automate those changes, the description of the automation process will be released under separate cover. In the interim, workers should use the following workarounds:

DESCRIPTION OF REVISIONS MADE TO FORMS

To support the policies described in this SR, changes were made to the following forms:

DFA Form 77R, Emergency Assistance (EA) for Housing: What You Need to Know

DFA Form 77R, Emergency Assistance (EA) for Housing: What You Need to Know, is a one-page double-sided pamphlet provided to individuals who wish to learn about Emergency Assistance. The form, including its Spanish and Nepali translations, was revised to include information about applying for and receiving Emergency Assistance for:

·      first month’s rent;

·      home heating fuel arrearages; and

·      subsidized housing.

Additionally, the address of the Keene District Office was revised and “State Office Park South” was changed to “Governor Hugh J Gallen State Office Park.”

Instructions for this form were updated accordingly.

DFA Form 77R(Bo), Bosnian Version of DFA Form 77R

DFA Form 77R(Bo), Bosnian Version of DFA Form 77R, 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 77R(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.

DFA Form 765, Application for Emergency Assistance

DFA Form 765, Application for Emergency Assistance, is a one-page, single-sided form used by individuals who wish to apply for Emergency Assistance funds. This form was revised to:

·      Remove “Please state why you need emergency assistance;”

·      Add a field for “Case Number if known.”

·      Add a field for the applicant to write the amount requested for first month’s rent;

·      Change “Water” to “Water/Sewer;”

·      Change “Wood” to “Wood/ Pellets;”

·      Add a field for “Past Due Amount;” and

·      Change “penalty of perjury” to “unsworn falsification”, and make other minor edits to the paragraph.

Instructions for this form were updated accordingly and Spanish and Nepali versions of this form are now available for distribution.

The old versions of DFA Forms 77R, its translated versions and instructions, and DFA Form 765 and its instructions must be recycled and the new versions used immediately. A Certificate of Destruction has been included in this SR.

A small supply of the new versions of DFA Form 77R and DFA Form 765 has been sent to each District Office as follows:

·      100 of both forms to Concord, Manchester, Southern, Seacoast, and Rochester District Offices; and

·      50 of both forms to the remaining DOs (including Main and Client Services, but not the Long-Term Care office).

Begin using the new version upon receipt, after recycling the old versions. The new English versions of the forms identified in this SR are available in the DHHS Warehouse and can be ordered using current forms reordering procedures, via the Quarterly Forms Order (QFO). The forms are also available electronically, for Department staff only, on the Lotus Notes Family Services Database. The forms may also be downloaded at the Department website at http://www.dhhs.state.nh.us/dfa/tanf/emergency.htm. Translated versions of DFA Form 77R and DFA Form 765 can be reordered by contacting the Supervisor of the Policy Development Unit.

POLICY MANUAL REVISIONS

Revised Family Assistance Manual Topics

Section 703.05  Emergency Assistance (EA) Eligibility Requirements

Section 703.07  Emergency Assistance Payment Limits

Section 703.13  When Expenses Exceed Maximum Allowable Amounts

Section 703.19  Emergency Assistance (EA) Verification Requirements

IMPLEMENTATION

The policies released in this SR are effective June 30, 2015.

The old versions of DFA Form 77R, its Spanish and Nepali versions, and its instructions, and DFA Form 765 and its instructions, must be recycled and the new versions used immediately. A Certificate of Destruction has been included in this SR.

All forms identified in this SR are available in the DHHS Warehouse and can be ordered using current forms reordering procedures, via the QFO. The forms are also available electronically, for Department staff only, on the Lotus Notes Family Services Database. The forms may also be downloaded at the Department website at http://www.dhhs.state.nh.us/dfa/tanf/emergency.htm. Translated versions of DFA Form 77R and DFA Form 765 can be reordered by contacting the Supervisor of the Policy Development Unit.

CLIENT NOTIFICATION

Notification of the EA rule amendments was published in the NH Rulemaking Register, Office of Legislative Services, on April 23, 2015. A public hearing on the amended Administrative Rules associated with this policy, He-W 606.104(a)-(b) and He-W 699.05, was held on May 20, 2015.

The Emergency Assistance information found on the DHHS website (http://www.dhhs.state.nh.us/dfa/tanf/emergency.htm) has been updated.

No other client notification is planned.

TRAINING

No special training is planned or 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 www.dhhs.nh.gov/DFA/publications.htm, effective June 29, 2015. 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 and Forms Manuals.

DFA/SMC:s