May 10, 2007

 

FOOD STAMP PROGRAM GUIDE

SPECIAL NOTICE

07- 09

CalWORKs PROGRAM GUIDE

SPECIAL NOTICE

07-11

 

Subject

SUPPLEMENTAL FORMS FOR THE FOOD STAMP (FSP) AND CALIFORNIA WORK OPPORTUNITY AND RESPONSIBILITY TO KIDS (CalWORKs)  PROGRAMS

 

Reference

All County Information Notice (ACIN) I-11-07

Manual of  Policies and Procedures (MPP) sections 40-101.12, 40-101.17,  63-102(p) (6), 63-300.21, 63-300.321, Federal Regulations 7 CFR 273.2(a) and 7CFR 273.2(b)

 

Effective Date

Upon Receipt

 

Purpose

The purpose of this joint Special Notice (SN) is to explain the difference in meanings and usages between “pre-screening” and “supplemental forms”.       

         

Background

·  Pre-screening forms are not permissible in the Food Stamp Program.  Staff is reminded not to impose or require applicants to complete any county developed pre-screening forms.  Pre-screening forms cannot be used to determine eligibility.

 

·  For Food Stamp applications, workers must use only the SAWS 1/SAWS2 or DFA 285 A1/DFA 285 A2.

 

·  County developed supplemental forms can be used as long as the form is not given to applicant in place of the Food Stamp application. 

 

Definitions

Pre-screening Form

Supplemental Form

This term describes a form used to collect eligibility data. 

 

Questions on pre-screening forms are generally duplicate in nature of those on the application prior to the household signing an application.  

This term describes a form used to gather information needed to begin an interactive interview.  In this form there is no duplication of eligibility questions.  This form is used after the initial application is signed. 

 

 


 

Applications
Parts         

Applications have two parts:

 

1) SAWS 1 or DFA 285 A1  and

2) SAWS 2 or DFA 285 A2 (Statement of Facts)

 

If at application these forms were distributed to applicant before the interview

Then ...

SAWS 1 or DFA 285 A1

 and

SAWS 2 or DFA 285 A2

Supplemental forms are unnecessary and should not be used.

SAWS1 or DFA 285A1

Supplemental form can be used to start the interactive interview.

 

CLARIFICATION

 

If at the initial contact with applicant only the SAWS 1 is used then a supplemental form can be used requesting the names and social security numbers of household members.  The worker can clear for existing information in CalWIN to update or enter new information and to schedule for Expedited Services.

 

Acceptable Supplemental Forms

Questions on supplemental forms cannot be asked prior to applicant completing and the County receiving a signed application back.

 

Acceptable supplemental forms should clearly have a statement informing applicants that they do not have to submit the form in order to apply for benefits.

 

Acceptable Supplemental forms include:

 

·  A form designed to ask an applicant about whether the household would like to get information on or referrals to Family Planning, Mental Health, Substance Abuse, Domestic Violence Counseling, Social Security/SSI application, Child care resources, etc…

 

·   A form designed to expedite the application process via automated systems and to improve the administrative operations process.

 

·   A form designed with no repetitive questions from the DFA285 and SAWS. Example: Do not ask the same Expedited Services (ES) information again in the Supplemental form.

                                                                            Continued on next page


 

 

Acceptable Supplemental Forms (continued)

When a supplemental form is used in conjunction with an interactive interview in CalWIN, the worker must first make a printout of the Statement of Facts (SAWS 2/DFA285 A2) for client to review the answers before asking the applicant to sign the electronically generated Statement of Facts.

 

CalWORKs Impact

For consistency, workers are discouraged from using pre-screening forms in any CalWORKs or Food Stamp (either PAFS or NAFS) case.

 

Forms Impact

Regional Operations are reviewing the “Welcome Form” and Business Processes to ensure we are in compliance with State regulations.

 

Quality Assurance Impact

QA will cite the appropriate error when the requirements in this material have not been followed.

 

Assistant Deputy Director

 

 

 

Original signed 05/10/07

 

DANN CRAWFORD

Assistant Deputy Director

Food Stamp, Medi-Cal and General Relief Programs

Strategic Planning & Operational Support

 

 

 

 

JAYE YOSHONIS

Assistant Deputy Director

CalWORKs Program

Strategic Planning & Operational Support