2.4 Applying for Services

2.4.1 Release of Information

To determine eligibility, an individual must apply for the Program. Contractors shall not prohibit any individual from applying for services.

Contractors must develop an application for the Program. At a minimum, the application must include:

1.             Date application is received;

2.             Contractor’s name, address, and telephone number;

3.             Applicant’s name, address, and telephone number;

4.             Household A cohabiting group that includes applicants, their biological, adoptive, or relative children and any children of the biological, adoptive, or relative children; the household also includes any non-martial co-parent or any spouse of the individual who resides in the same household as the individual and any biological, adoptive, or relative children with respect to whom the spouse or non-marital co-parent is a parent or a relative and primary caregiver. information including the name of all persons living in the household, social security number, dates of birth, gender, marital status, citizenship or qualified alien status, and relationship to the applicant An individual applying for services in TJ or TMJ.;

5.             Applicant nonfinancial eligibility information:

a.             Child support status (e.g., payer and KIDS case number);

b.             Child welfare reunification status (e.g., children placed out-of-home and expected date of reunification);

c.              Offender status (e.g., convicted of a misdemeanor or felony);

d.             In or out of out-of-home placement (e.g., foster care, kinship care, independent living facilities, residential care centers, group homes) under a Chapter 48 or Chapter 938 court order (Child in Need of Protection or Services orders (CHIPS), Juvenile in Need of Protection or Services orders (JIPS), or Juvenile Delinquency orders);

e.             Receiving W-2 benefits or services;

f.                Receiving unemployment insurance benefits;

g.             Last date of employment and hours worked within the work of the last day of employment;

h.              Previous enrollment in the Program and hours worked;

i.                Questions that assess the applicant’s ability to obtain and benefit from a subsidized job;

6.             Household financial eligibility information:

a.             Gross earned income Money, wages or salary, adjusted income from self-employment, Social Security, dividends, interest on savings or bonds, income from estates or trusts, net rental income or royalties, public assistance, SSI, pensions and annuities, unemployment insurance, worker’s compensation, alimony and other maintenance payments, and veteran pensions. of household members in the last twelve calendar months;

b.             Unearned income of household members in the last twelve calendar months and types of unearned income; and

c.              Household members’ assets and types of assets;

7.             A description of the types of documentation an applicant may need to provide in order to verify information needed to determine eligibility for the Program; and

8.             Signatures and date signed by the applicant and the authorized staff receiving the application.

Contractors may develop acknowledgements to provide information to applicants on the terms of the application including:

• A statement that the applicant understands and agrees to provide documentation to prove the information provided by the applicant.

• A statement authorizing the Contractor The entities under contract with DCF to administer the TJ and TMJ contracts. to request and receive any information that is appropriate and necessary for the proper administration of the Program.

• An acknowledgement that the applicant understands the questions in the application and the answers provided are correct and complete to the best of the applicant’s knowledge.

• A statement that the applicant must notify the Contractor of a change in circumstance that may affect eligibility within ten (10) calendar days of its occurrence.

• Penalties for providing false information or failing to report eligibility changes timely.

• A complaint resolution process (see 2.7).

• Basic participation requirements for an individual enrolled in the Program.

• A statement that the SJ may either affect benefits applicants receive from other programs, or income from the SJ may be affected by other programs.

2.4.1 Release of Information

When an applicant has made a reasonable effort and cannot obtain required verification, does not have the power to produce the verification, or requires assistance to do so, the Contractor must assist the applicant.

Contractors must develop a form authorizing a third party to release information for the purposes of the administration of the Program. At minimum, the form must include:

1.             The individual who is the subject of record and any applicable identifying information.

2.             The person or organization to whom the information may be released.

3.             The person or organization being authorized to release information.

4.             A description of records authorized for release.

5.             The purpose or need for release of information.

6.             A statement that authorizes the disclosure of records to the person or organization to whom the information may be released.

7.             An authorization expiration date.

8.             A signature for the individual who is the subject of record.

9.             A signature for the other person legally authorized to consent to disclosure.

History: There are no previous versions of this policy.