016.20.98 Ark. Code R. 021

Current through Register Vol. 49, No. 9, September, 2024
Rule 016.20.98-021 - TEA 98-8, IMF 98-7, FSC 98-12 - Simplified Food Stamp Program
10000Intent of Simplified Food Stamp Program

The Simplified Food Stamp Program (SFSP) provides TEA Cash Assistance Program participants with their basic food needs while the parent or other adult relative works toward increasing his or her earnings potential.

10010Program Design

The following SFSP requirements will be based on TEA policy: residency, Social Seciuity Numbers, income and resources. (NOTE: The TEA Cash Assistance payment must be counted as income in the SFSP budget.)

Households that participate in the SFSP will not have to meet any work requirements in addition to the TEA Cash Assistance Program work requirements. TEA Cash Assistance recipients who are students will not have to meet the Food Stamp Program student requirements. SFSP participants will have no change reporting requirements in addition to the TEA Cash Assistance reporting requirements.

OTIZENSHIP REQUIREMENTS FOR FOOD STAMP PROGRAM RECIPIENTS ARE BASED ON LAW AND CANNOT BE WAIVED. ANYONE WHO IS NOT A U.S. CITIZEN MUST MEET THE REGULAR FOOD STAMP PROGRAM CITIZENSHIP REQUIREMENTS AS SPECIFIED IN TEA 10101 BEFORE HE OR SHE IS ALLOWED TO PARTICIPATE IN THE SFSP.

10020Household Composition

A food stamp household must meet one of the following descriptions:

* An individual who lives alone.

* A group of individuals who live together and customarily purchase food and prepare meals together.

* An individual or a group of individuals who live with others and customarily (more than 50% of the time) purchase food and prepare meals for home consumption separate and apart from the others.

* An individual who is living with others but is unable to purchase and prepare meals due to a permanent disability such as, but not limited to, senility. This type of household may include the individual and his or her spouse regardless of the physical condition or age of the spouse. All income of the individual or the spouse will be counted in the food stamp budget. The income of all other household members will be disregarded; however, the total gross non-excludable income of all other household members may not exceed 165% of the maximum net income standard as shown on the Food Stamp Basis of Issuance Charts. Exhibit A.

Separate household status will not be granted under any circumstance to:

* The spouse of a hoxisehold member;

* Children under the age of 22, regardless of marital status, who live with a natural, adoptive, or stepparent;

* Siblings, regardless of marital status, who live together if one sibling is age 17 or younger; or

* Children under the age of 17, regardless of marital status, who are imder the parental control of another household member even if that household member is not a parent or a sibling.

Individuals under the age of 22 who do not meet one of these restrictions may participate in the Food Stamp Program as a separate household if otherwise eligible.

10100Households to be Served in the Simplified Food Stamp Program

Only households where all household members receive TEA Cash Assistance fir a combination of TEA Cash Assistance and SSI benefits will participate in the SFSP. Households with children not added to the TEA Cash Assistance grant solely due to the family cap provisions of TEA 4131 will participate in the SFSP. These children will be included in the SFSP household.

Households with children not added to the TEA Cash Assistance grant solely due to the family cap provisions are not categorically eligible to receive food stamp benefits. These households must meet the Food Stamp Program resource limits and the gross income limits for the SFSP household including the cMld affected by the Family Cap provisions. See TEA 10104-10106 for additional information.

Households that participate in the SFSP will be classified on the Food Stamp Automated Customer Tracking System (FACTS) as public assistance (PA) households.

8/1/98

Recipients of TEA Diversion Assistance as specified in TEA 2010 will not participate in the SFSP. Any Diversion Assistance recipient who is not currently receiving food stamp benefits may submit a Food Stamp Application(DCO-220) through the county office's normal procedures. Diversion Assistance recipients will be classified as NA households on the Food Stamp Automated Customer Tracking System (FACTS).

10101Citizenship Requirements for SFSP

Participation in the SFSP is limited to U.S. citizens and to the non-citizens described in this section.

For up to five years from the date of admission under one of the specified criteria, any alien who:

* Was granted asylum under Section 208 of the IN A;

* Was granted status as a refugee under Section 207 of the INA;

* Had deportation withheld under Section 243 (h) or, after April U 1997, Section 241 (b)(3) of the INA;

* Was admitted as an Amerasian immigrant pursuant to Section 584 of the Foreign Operations, Export Financing and Related Programs Appropriations Action of 1988; or

* Is a Cuban or Haitian entrant under 501(e) of the Reftigee Assistance Act of 1988.

For refugees admitted under Section 207 of the INA, fhe five year count begins the date the alien was granted the particular status. For other aliens, the five year count begins the date the alien was granted the particular status.

For an unJimitgd period;

1. Any alien who is currently admitted for permanent residence as defined in Section 101 (a) (2) of the INA and who:

* Can be credited with 40 quarters of qualified work (their own, a spouse's or a parent's); or

* Is a veteran of or is on active duty in the U.S. armed forces; or

* Is the spouse or dependent child of an individual who is a veteran of or who is on active duty in the U.S. armed forces.

2. Any alien who is a veteran of or is on active duty in the U.S. armed forces OR any alien who is the spouse and/or dependent child of an individual with a military connection if the alien:

* Was granted asylum under Section 208 of the IN A;

* Was granted status as a refugee under Section 207 of the IN A;

* Had deportation withheld under Section 243(h) or, after April 1,1997, Section 241 (b)(3) of the INA;

* Is a Cuban or Haitian entrant under Section 501 (e) of the Refugee Assistance Act of 1988;

* Is a conditional entrant under Section 203(a) (7) of the INA; or

* Has been a parolee for at least one year under Section 212 (d) (5) of the INA.

3. Under certain conditions, an alien who is a battered spouse or battered child of a veteran or a person who is on active duty in the U.S. armed forces. The nonabusive parent of a battered child or the dependent child of a battered spouse may also meet the citizenship requirements under this provision.

A qualifying quarter of work as specified in item 1 above includes one worked by the alien, one worked by a parent (natural adoptive or step) of an alien while the alien was under the age of 18. It also includes any quarter worked by a spouse during the marriage if the alien remains married to the spouse or the spouse is deceased. Any quarter during which the alien received SSI, Medicaid or TEA is not a qualifying quarter of work.

Ineligible aliens include all other aliens such as, but not limited to:

* Visitors and tourists;

* Students;

* Diplomats;

* Aliens admitted imder color of law;

* Aliens who have applied for eligible status but have not yet been approved (except for battered spouses and/or children with a military connection); and

* Aliens whose status is questionable or unverified.

10102Verification of Citizenship

One of the following documents may be presented by the alien to establish that he or she is legally present in the United States:

* Alien Lawfully Admitted For Permanent Status - INS Form l-55\. Alien Registration Receipt Card. OR unexpired temporary 1-551 stamp in foreign passport or on INS Form 1-94, Arrival/Departure Record.

* Asylee - INS Form 1-94, Arrival/Departure Record, annotated with stamp showing grant of asylum under Section 208 of the Immigration and Nationality Act (IN A) OR INS Form I-688B, Employment Authorization Card, annotated with stamp showing admission under Section 207 of the INA.

* Refugee - INS Form 1-94, Arrival/Departure Record, annotated with stamp showing admission under Section 207 of the INA.

* Alien Paroled Into The U.S. For At Least One Year - INS Form T-94, Arrival/Departure Record, with stamp showing admission for at least one year under Section 212 (d) (5) of the INA.

* Alien Whose Deportation or Removai Was Withheld - Order from an immigration judge showing deportation withheld imder Section 243 (h) of the INA as in effect prior to April 1,1997, or removal withheld under Section 241 (b) (3) of the INA after April 1,1997.

* Alien Granted Conditional Entry - INS Form 1-94, Arrival/Departure Record, with stamp showing admission under Section 203 (a) (7) of the INA.

* Cvbaw/Haitian Entrant - INS Form 1-551, Alien Registration Receipt Card, with the code CU6, CU7 or CH6, OR unexpired temporary 1-551 stamp in foreign passport or on INS Form 1-94, Arrival/Departure Record, with stamp showing parole as Cuban/Haitian Entrant under Section 212 (d) (5) of the INA.

* Amerasian Immigrant - INS Form 1-551. Alien Registration Receipt Card, with the code AM6, AM7, or AM8, OR unexpired temporary 1-551 stamp in foreign passport or on INS form 1-94, Arrival/Departure Record, with the code AMI, AM7, or AM3.

* Battered Alien - Evidence of having petitioned INS for permanent resident status and reasonable proof of battery. Reasonable proof of battery includes, but is not limited to, police reports, information from medical or school personnel, and/or photographs. A collateral statement may be accepted to verify that the battered individual no longer lives with the batterer.

Aliens who are applying to participate in the SFSP based on military service must first provide documentation that he or she meets the citizenship requirements of TEA 10010. Then he or she must provide verification that he or she meets minimimi active duty service requirements. Veterans must provide documentation of an honorable discharge for reasons other than alienage.

A surviving spouse of a deceased veteran must provide verification that the marriage meets the requirements of Section 1304 of Title 38 U.S.C. Battered aliens must provide documentation of being battered and of having petitioned INS for permanent resident status.

The Social Security Administration is the primary source of verification of qualifying quarters of work. An automated system has been developed to provide an array, by year, beginning with 1937, of all qualifying quarters of work. Appendix Q to the Food Stamp Certification Manual provides complete information about verifying qualifying quarters of work through the automated system.

10103Special Income and Resource Guidelines - Ineligible Aliens

Some aliens may be eligible to participate in the TEA Program but not eligible to participate in the SFSP. The resources of these ineligible aliens will be counted in their entirety. A prorata share of the income of these ineligible aliens will be counted in the SFSP budget. If the alien is the payee for the TEA Cash Assistance, a prorata share of the TEA Cash Assistance will be counted in the SFSP budget.

To calculate the prorata share of the income to be counted:

* Determine the alien's gross countable income as instructed in TEA 2330 - 2341.

* Divide the gross income among all household members including the ineligible alien to obtain the prorata amount for each member.

* Multiply the number of eligible members by the prorata amount.

* Count the result as income in the SFSP budget.

Medical expenses and dependent care costs are not deductible. Other deductible expenses will be allowable. These expenses will not be prorated unless the ineligible alien incurs part or all of the expense. If the ineligible alien does incur part or all of the expense, the expense will be prorated using the same method as the method used for proration of income.

10104Special SSNRequirements - Family Cap Households

Children who are not included in the grant due to the family cap provisions must provide a social security number (SSN) or apply for an SSN before they can receive food stamp benefits. If the child cannot provide an SSN, the county office worker will complete an Application for an SSN (SS-5) and an Enumeration Referral(DCO-12). ApseudoSSN will be entered on the DCO-12 to insure enumeration occurs. Both forms must be mailed to local SSA office.

The Food Stamp Program SSN requirement may be delayed for up to two full calendar months after the month of birth for newborn children while the parents obtain an SSN for the child or obtain the birth proof needed to apply for an SSN. The child may participate in the SFSP while the SSN requirement is postponed.

Delay of the SSN requirement will not apply if a form SSA-2853 was completed for a newborn by a hospital. When the parent provides a copy of the SSA-2853, the county office may complete an SS-5 and DCO-12. When these documents are sent to SSA, the household has complied with the SSN requirement.

If the SSN requirement is postponed, the household must be notified that proof of compliance with the SSN requirements must be provided before the end of the second calendar month of the postponement or the child will be disquEilified to receive food stamp benefits. If this information is not provided by the end of the second calendar month, action must be taken to disqualify the child.

To disqualify a member for non-compliance with the SSN requirements:

* Use a household status code "9" in the member segment of the WFSM screen.

* Include all of that member*s resources.

* Count a prorata share of the member's income.

* Do not allow any expense incurred entirely by the disqualified member.

* Allow a prorata share of any shared expense.

* Include the disqualified member when determining the food stamp benefit amount.

10105Special Resource Guidelines - Family Cap Households

The resource limits for SFSP households with a child not added to TEA Cash Assistance due to the family cap provision are $3,000 for any household with an aged member, regardless of household size, and $2,000 for all other households. If the household's countable resources exceed the resource limits, the household will be ineligible to receive food stamp benefits.

Only the resources owned solely or jointly by a child who was not added to the grant due to the family cap provision will be counted in determining the household's countable resources for food stamp eligibility. (Resources owned solely by an SSI and/or TEA recipient are excluded in their entirety.) If one of these children has resources, see TEA 2270 - 2277.6 for instructions on determining countable resources.

10106Special Income Guidelines - Family Cap Households

Households with at least one child not added to TEA Cash Assistance due to the family cap provisions must meet the Food Stamp Program gross income limits in order to participate in the SFSP. See the Food Stamp Basis of Issuance Charts, Exhibit Ay for the current gross income limits. Any income received by children who are not included in the grant due to the family cap provision will be considered when the food stamp benefit amount is determined. TEA policy 2330 - 2341 will be used to determine the amount of countable income.

10107Special Income and Resource Guidelines - SSI Recipients

The income of any SSI recipient who participates in the SFSP will be counted as income to determine food stamp benefit level. If there is a child in the home affected by the family cap provision, the household is not categorically eligible; therefore, the household must meet the Food Stamp Program gross income limits in order to participate in the SFSP. Any SSI payment received will be counted as income in the SFSP budget.

See TEA 2330-2341 for instructions on determining countable income. Resources owned by the SSI recipient will be excluded.

10200Applying to Participate in the Simplified Food Stamp Program

Households that submit an application to participate in the TEA Cash Assistance Program will also have submitted an application to participate in the SFSP. Page one of The TEA Cash Assistance application will contain the information necessary to determine food stamp eligibility and to screen for expedited services.

If the household is already participating in the regular Food Stamp Program, the household will be converted to the SFSP as explained in TEA 10400.

When some of the household members are not included in the TEA Cash Assistance case for any reason except the family cap provision or receipt of SSI, the household must submit a Food Stamp Application.DCO-220, through the county office's normal procedures in order to receive food stamp benefits. These households v«ll be classified as NA households.

10201Certifying Households Under Regular Food Stamp Program Rules

Food stamp benefits will be authorized under regular Food Stamp Program rules for TEA Cash Assistance applicants when:

* The household is entitled to expedited service for food stamp benefits;

* Eligibility for TEA Cash Assistance benefits cannot be determined within 30 days; or

* The TEA Cash Assistance portion of the application is denied, but the household may be eligible for food stamp benefits under regular Food Stamp Program rules.

Eligibility will be established under regular Food Stamp Program rules using the TEA application if the TEA application is approved but one or more household members are not included in the TEA assistance grant for reasons other than the family cap provisions or receipt of SSI. See TEA 10202 and TEA 10203 for additional information.

Pages one and two of the TEA application, along with the information on the remainder of the TEA application, should contain adequate information to determine eligibility under the normal Food Stamp Certification (FSC) policy for both expedited and non-expedited households. An interview must be conducted by a county office worker before food stamp eligibility can be established. In most instances, this will be the TEA interview.

If additional information is needed to establish eligibility under regular Food Stamp Program rules, this information may be requested via the Notice of Delayed Food Stamp Application(DCO-206). The household must be allowed at least 10 days or until the end of the TEA application processing period to provide this information.

If eligibility for food stamp benefits is delayed due to a request for additional information and the TEA application is approved prior to receipt of the requested information, eligibility for food stamp benefits will be determined at the time the TEA application is approved. The rules applicable to the SFSP will be applied when the food stamp application is approved.

Food stamp applications processed under regular Food Stamp Program rules will be registered and, if the household is ineligible, denied using the area provided on page 1 of the TEA application. The date of the TEA application is also the date of the food stamp application. When a food stamp application is approved, the food stamp benefits will be prorated to the date of the TEA application. The household will not be considered to be at fault for any application processing delays past 30 days.

Any household that submitted only a TEA application but was certified under regular Food Stamp Program rules will be assigned a certification period no longer than three months. (Expedited households certified pending verification will be assigned a one or two month certification period as explained in TEA 10202.) The household will not be placed on quarterly reporting.

If a household is certified under regular Food Stamp Program rules and the TEA application is later approved, the household will be converted to the SFSP as instructed in TEA 10400. When the household is converted to the SFSP, the certification period will be extended to a maximum of 12 months with no additional interview required.

If the household is not converted to the SFSP for any reason, a normal recertification must occur at the end of the certification period. At recertification, a Food Stamp Application(DCO-220) must be completed and submitted by the household and an interview must be conducted.

DECISION POINTGeneral guidelines have been provided for determining food stamp

eligibility for TEA applicants based on regular Food Stamp Program rules. Each county will apply these procedures in accordance with the county's internal procedures for processing both regular and expedited food stamp applications. For example, if there is a Unit in the office which determines food stamp eligibility for NA households, that Unit could work with a copy of the TEA application to determine food stamp eligibility under regular Food Stamp Program rules.

10202Certifying SFSP Applicants Under the Expedited Provisions

The following SFSP applicants must be provided with food stamp benefits within seven calendar days of the date of application:

* Households with $100 or less in countable liquid resources and less than $150 in gross monthly income;

* Eligible households whose total combined gross monthly income and liquid resources are less than the amount incurred by the household for its utilities and rent or mortgage payment; or

* Destitute households with $100 or less in countable liquid resources. A household may not be considered destitute unless it contains migrant or seasonal farmworker members in the job stream.

There are questions on page 1 of the TEA AppHcation (DCO-180) that are designed to help identify households entitled to expedited service.

Verification of the following items may be postponed for households entitled to expedited service: residency, income, liquid resources, actual utilities, medical costs, and alien status. Identity must be verified. When verification is postponed, expedited households will be assigned a one month period of certification unless the application was submitted after the 15th of the month and approved the same month. If so, the household will be assigned a two month period of certification.

There is no limit to the number of times a household may be certified under the expedited service provisions. However, prior to each subsequent expedited certification, the household must either complete the verification requirements that were postponed or be certified under normal processing standards.

10203Work Registration Requirements - Regular Food Stamp Program

Food Stamp Program work registration exemptions are allowed for the following household members:

1. Age 15 or younger
2. Age 16 or 17 and living with a parent or attending a school or training program on at least a half-time basis
3. Age 60 or older
4. Disabled
5. Caring for a dependent child under age 6 or an incapacitated person of any age
6. Receiving unemployment benefits
7. Participating in a treatment program for alcoholism or drug addiction
8. Employed or self-employed on a full-time basis
9. Enrolled full-time in a high school or an institution of higher education
10. Receiving TEA Cash Assistance

All other household members are subject to the work registration requirements.

When the household signs the TEA Application, DCO-180, non-exempt household members are automatically registered for work. If the TEA Application is denied after the household has been certified for food stamp benefits and not all household members are exempt from work registration, a Notification of Work Registration(DCO-260) will be issued to the household. A DCO-260 will also be issued if the TEA Application is approved, the household is not eligible to participate in the SFSP, and some household members will be subject to work registration under Food Stamp Program rules.

10204Medical Deductions - Regular Food Stamp Program

Since most individuals who participate in the SFSP have Medicaid coverage, no medical deduction will be allowed in the SFSP. However, in some instances, a medical deduction must be calculated for TEA applicants certified under regular Food Stamp Program rules. Under regular Food Stamp Program rules, a deduction will be given for allowable medical costs in excess of $35 per month when such costs are incurred by a household member who is age 60 or older or who is in receipt of disability benefits based on permanent and total disability.

The following medical costs are allowable:

* The cost of attendants, home health aides, disabled child care services, or homemakers when such services are required due to the disability or illness of the aged or disabled member.

* Corrective devices such as, but not limited to, dentures, braces, eye glasses, hearing aids, or prosthetic devices.

* Hospital and nursing home care.

* Health and hospitalization policy premiums not to include health and accident policies payable in lump sum settlements.

* Medical and dental care.

* Medical equipment and supplies.

* The purchase, maintenance and training of seeing eye dogs and other service animals for the disabled.

* Prescription drugs including over the counter medication recommended or prescribed by a health care professional.

* Transportation and lodging incurred to obtain medical treatment.

Monthly expenses will be anticipated based on the best information available. Monthly expenses will be allowed. Periodic expenses will be allowed if the expense is regularly recurring and can be reasonably anticipated. If a periodic expense is allowed, the household may choose to use the entire expense in the month incurred or to average the expenses over the period of use. A one-time expense may be allowed if the expense was incurred within the 30 calendar day period prior to the month of application or if payment on the expense will otherwise become due in the month of application. The household may choose to,allow the entire one-time expense in the month incurred or to average the expense forward over the assigned certification period. Past due medical costs are not allowed. Any portion of the medical expense to be reimbursed will not be allowed. All medical expenses must be verified.

10205Dependent Care Deduction - Regular Food Stamp Program

Since child care costs will be paid for individuals who receive TEA Cash Assistance, no dependent care deduction will be allowed in the SFSP. However, in some instances, a dependent care deduction must be calculated for TEA applicants certified under regular Food Stamp Program rules. Under regular Food Stamp Program rules, a deduction will be given for costs for the actual care of a child or other dependent person incurred to allow a household member to work or to pursue education preparatory to work. Dependent care costs are limited to $200 per month for a dependent imder age 2 or $175 per month for a dependent age 2 or older.

10210Authorizing Food Stamp Benefits

The following deductions will be allowed in the SFSP.

Earned Income Deduction

This is 20% of the household's gross earned income.

Standard Deduction

This is $134.

Child Support Deduction

This is an average of the legally obligated child support payments made in the last three months by a household member to an individual who is not a household member.

Excess Shelter Deduction for TEA Households With No Aged/Disabled Members

This is the household's total allowable shelter cost in excess of 50% of the household's income after all other allowable deductions. A standard shelter cost will be assigned to each household that incurs a shelter cost. The standard shelter cost includes the rent (or mortgage payment, taxes and insurance) and the utility costs. The standard shelter cost differs from county to county. A standard shelter cost table appears in TEA 10213.

Excess Shelter Deduction for TEA Households With Agedmisabled Members

This is the households total allowable shelter cost in excess of 50% of the household's income after all other allowable deductions. There are special shelter cost provisions that apply to SFSP households that contain either a member age 60 or older or a member who receives SSI. These households will be allowed to choose between using the standard shelter cost or the household's actual verified shelter costs in the food stamp budget. A list of allowable shelter costs appears in TEA 10211. A standard shelter cost table appears in TEA 10213.

10211Actual Shelter Costs

Only the following items will be an allowable shelter cost:

* Continuing, not past due, charges for the shelter occupied by the household.

* Current property taxes on the household's shelter.

* Current, not past due, insurance charges on the household's shelter not to include separate identifiable costs for insuring furniture or personal belongings.

* Current, not past due, utility costs for cooking fuel, heating fuel, cooling, electricity, water, sewer, garbage, trash collection and fees for installation of utilities.

* Current, not past due, basic service fee for one telephone including tax on the basic fee, installation charges and line access charges.

* Current, not past due, shelter costs for a home temporarily unoccupied by its owners because of employment or training away from home, illness, a natural disaster, or casualty loss.

* Current, not past due, unreimbursed charges for repair of a home damaged or destroyed due to a natural disaster or casualty loss.

* For homeless households, a shelter estimate of $143 imless the actual costs are higher.

The county office worker may accept any documentation that establishes the household's current actual shelter costs. Such docimientation includes, but is not limited to, current receipts or bills or statements fi"om the provider.

10212Authorizing the Correct Benefit Amount

In order to authorize the correct amount of food stamp benefits, the county office worker must prepare a budget. The budget may be prepared on a Food Stamp Authorization Document(DCO-233), or the worker may print a copy of the current Food Stamp Master File (WFSM) screen and indicate the new budget in red on this copy.

SIGNED COPIKS OF ALL AUTHORIZATION DOCUMENTS ARE ESSENTIAL THE INITIAL ACTION TO AUTHORIZE SFSP BENEFITS AND EVERY BUDGET CHANGE MUST BE DOCUMENTED IN THE TEA CASE RECORD

A copy of any document used to authorize any subsequent changes in the food stamp benefit amount must appear in the TEA case record. If the SFSP case is closed, a copy of the document used to close the SFSP case must appear in the TEA case record. THESE DOCUMENTS WILL SERVE AS THE COUNTY'S RECORD OF WHEN BENEFITS WERE AUTHORTy.EP Am[GREATER THAN] WHO AUTHOmZEP THEM.

DECISION POINT Each county will designate how the SFSP documents will be filed

in the TEA case record. The county may designate a special section for SFSP documents or may intermingle SFSP documents with the TEA documents in a certain specified order. No matter what method of filing SFSP documents is chosen by the county, the same method must be used consistently throughout the county office. Also, the method must allow a reviewer to determine when food stamp benefits were authorized for the household and what figures were used to calculate the current benefit amount. If a household's food stamp benefits are ended, the reviewer must be able to determine when the benefits were ended and whether this

was a valid decision.

To prepare a budget, the worker will complete the following steps on either the DCO-233 or the copy of the WFSM screen:

Step 1 Determine gross monthly earned income as per TEA 2343-2344. Include any income received by household members prohibited from receiving TEA Cash Assistance benefits solely due to the family cap provision. Round individual earned income amounts up or down to the nearest dollar. Add individual rounded amounts together. Enter total in field 35.

Step 2 Calculate the earned income deduction by multiplying total gross earned income by 20%. Round this figure up or down to the nearest dollar. Enter the rounded figure in field 36.

Step 3 Subtract the earned income deduction from the gross earned income. The result is called the net earned income. Enter this figure in field 37.

Step 4 Determine gross unearned income as per TEA 2330-2331. TEA CASH

ASSISTANCE WILL BE COUNTED AS UNEARNED INCOMEEnter individual amounts (rounded up or down to the nearest dollar) in fields 38-48. Enter the total in field 49.

Step 5 Add together the net earned income and the gross uneamed income. The result is called the household's gross income. Enter this in field 51.

Step 6 Subtract the standard deduction of $134. Enter the standard deduction in field 52 and then subtract field 52 from field 51. Enter the resuh in field 53.

Step 7 If a household member makes child support payments, enter the child support deduction (rounded up or down to the nearest dollar) in field 55a and then subtract field 55a from field 53. Enter the result in field 56. If there is no child support deduction, bring the figure in field 53 down to field 56. The result is called the adjusted income.

Step 8 If the household has shelter costs, enter the applicable shelter standard fi-om TEA 10211 or (for households with an aged or disabled member) the actual shelter costs (imrounded) in field 61. Enter a code A in field 59.

Step 9 Calculate 50% of the adjusted income firom Step 7. (Round resulting figure up or down to the nearest dollar.) Enter this in field 62.

Step 10 Subtract field 62 fi-om field 61. If the result is greater than 0, the household has an excess shelter deduction. Enter this in field 64. This is the excess shelter deduction. An excess shelter deduction may not exceed $250 unless there is a household member age 60 or older or an SSI recipient in the home. If there is a household member age 60 or older in the home, enter a code 1 in field 63. If there is an SSI recipient in the home, enter a code 2 in field 63. (Only when a code 1 or 2 appears in field 63 will the food stamp system allow shelter costs in excess of $250.)

Step 11 Subtract any excess shelter deduction in field 66 from field 65. The result is the net monthly income. Enter the result in field 67.

Step 12 Enter the number of eligible household members in field 68.

Step 13 Enter the maximum food stamp benefit amount for the household size as specified in the Food Stamp Basis of Issuance Tables in field 69 or go to Step 14.

Step 14 Multiply the net monthly income in field 67 by 30%. The result is the reduction rate. Enter the reduction rate in field 70.

Step 15 Subtract the reduction rate in field 70 fi*om the maximum benefit amount in field 69. The result is the household's food stamp benefit amoimt. Enter the food stamp benefit amoxmt in field 71 ,

10213Shelter Standard by County

COUNTY

standard

COUNTY

standard

COUNTY

standard

01 - Arkansas

$155

26 - Garland

$196

51 - Newton

$221

02 - Ashley

$167

27 - Grant

$219

52 - Ouachita

$176

03 - Baxter

$245

28 - Greene

$184

53 - Perry

$224

04 - Benton

$224

29 - Hempstead

$191

54 - Phillips

$183

05 - Boone

$210

30 - Hot Spring

$183

55 - Pike

$145

06 - Bradley

$133

31 - Howard

$188

56 - Poinsett

$172

07 - Calhoun

$145

32 - Independence

$231

57 - Polk

$165

08 - Carroll

$208

33 - Izard

$217

58 - Pope

$202

09 - Chicot

$151

34 - Jackson

$146

59 - Prairie

$151

10-Clark

$174

35 - Jefferson

$168

60 - Pulaski

$167

11-Clay

$186

36 - Johnson

$182

61 - Randolph

$237

12 - Cleburne

$230

37 - Lafayette

$172

62 - Saline

$183

13 - Cleveland

$183

38 - Lawrence

$218

63 - Scott

$165

14 - Columbia

$175

39-Lee

$170

64 - Searcy

$199

IS - Conway

$215

40 - Lincoln

$166

65 - Sebastian

$183

16 - Craighead

$173

41 - Little River

$223

66 - Sevier

$207

17 - Crawford

$200

42 - Logan

$219

67 - Sharp

$195

18 - Crittenden

$157

43 - Lonoke

$170

68 - St. Francis

$164

19 - Cross

$222

44 - Madison

$262

69 - Stone

$225

20 - Dallas

$187

45 - Marion

$248

70 - Union

$185

21 - Desha

$146

46-Miller

$214

71 -VanBuren

$157

22 - Drew

$175

47 - Mississippi

$197

72 - Washington

$239

23 - Faulkner

$218

48 - Monroe

$157

73-White

$226

24 - Franklin

$208

49 - Montgomery

$198

74 - Woodruff

$178

25 - Fulton

$212

50 - Nevada

$190

75-Yell

$180

10220Certification Periods

Households participating in the SFSP will be assigned a 12 month certification period. At any periodic review described in TEA 4101.1 or 4101.2, the certification period may be extended for up to 12 additional months. Certification periods shorter than 12 months may be assigned if TEA Cash Assistance eligibility will cease before the end of the 12 month period. Also, certification periods shorter than 12 months may be assigned at the discretion of the county administrator.

The household will not be required to submit an application for a certification period to be extended in the SFSP. However, an application approval must be keyed in order to extend the certification period.

SHE TEA 1Q2Q1 FOR INFORMATION ON ASSIGNTNG CRRTIFICATION PKRTODS TO TEA APPLICANTS CERTIFIED UNDER REGULAR FOOD STAMP PROGRAM RULES.

DECISION POINT We must assign a 12 month certification period to households

participating in the SFSP. While counties are not required to do a recertification, they are required to have some contact with the household at the end of the 12 month certification period. (This will not apply if the household's certification period was extended at aperiodic review.)

Each county must devise a method of tracking when certification periods end for SFSP participants and for insuring these certification periods are properly extended. For example, each county receives a Notice of Food Stamp Certification Expiration (DCO-239) or an equivalent report for each household whose certification period is expiring. The county may use these documents to identify households participating in the SFSP whose certification will be expiring. The county may also develop an internal tracking system for these cases.

Each county must also devise a method of contacting these households to insure that the household is still eligible to receive food stamp benefits through the SFSP. Such a method may be as simple as contacting the household by telephone to insure that there has been no change in income, resources or household composition which will affect the household's entitlement to participate in the SFSP. The county may also choose to bring the household into the office for an interview.

10230Proration of Benefits

When a household who is not currently participating in the regular Food Stamp Program makes a TEA Cash Assistance application, benefits for the first month of participation in the SFSP will be prorated to the date on which the TEA Cash Assistance application was filed. If a prorated food stamp benefit is less than $10.00, no benefits will be issued.

The Food Stamp Automated Customer Tracking System (FACTS) automatically calculates prorated initial food stamp benefits based on the date of application. When a TEA Cash Assistance applicant's eligibility for the SFSP is authorized, the date of application keyed to the FACTS system must be the date the TEA Cash Assistance application was submitted to the county office. In some instances, it may be necessary to manually calculate prorated benefits. For example, if retroactive benefits are authorized as instructed in TEA 10261, prorated benefits must be calculated manually.

Should it be necessary for any reason to calculate prorated benefits manually, the following table may be used. To use this table, locate the date of application, then multiply the full monthly benefit amount by the corresponding multiplication factor.

DATE OF APPLICATION

MULTIPLICATION FACTOR

DATE OF APPLICATION

MULTIPLICATION FACTOR

1

1.0000

17

.4667

2

.9667

18

.4334

3

.9334

19

.4000

4

.9000

20

.3667

5

.8667

21

.3334

6

.8334

22

.3000

7

.8000

23

.2667

8

.7667

24

.2334

9

.7334

25

.2000

10

.7000

26

.1667

11

.6667

27

.1334

12

.6334

28

.1000

13

.6000

29

.0667

14

.5667

30

.0334

15

.5334

31

.0334

16

.5000

10240Minimum Benefit Amount

In the SFSP, the minimum food stamp benefit for eligible one and two person households in the SFSP is $10.00. The minimum benefit for households with three or more members is $2.00.

10250Aggregate Benefits

An aggregate food stamp benefit amount includes the family's food stamp benefits for the month of application aid the following month. An aggregate food stamp benefit amount will be issued when a TEA Cash Assistance application is approved if the TEA Cash Assistance application was submitted after the 15th of the month and is approved before the end of the same month. If the prorated food stamp benefit amount for the month of application is less than $10, only the household's benefits for the following month vdll be issued. However, these benefits will be issued when the application is approved.

Aggregate benefits are authorized via the RETRO fields of the Food Stamp A uthorization Document (DCO-233). See DCOUM 7300 for additional instructions.

10260Issuance

Food stamp benefits will be issued via the Electronic Benefits Transfer (EBT) system.

In the EBT system, food stamp benefits are accessed through a point-of-sale (POS) device by using a magnetic stripe plastic card. Families who participate in the SFSP may receive either one or two EBT cards to access their TEA Cash Assistance and food stamp benefits. Each EBT card contains the cardholder's name and a Primary Account Number (PAN) which is unique to each individual card.

A personal identification number (PIN) is assigned to each food stamp benefit recipient. The PIN is known only to the recipient. The PIN can only be changed at the recipient's request.

Except for Jefferson County, EBT cards are issued through the mail by a contractor. Issuance of an EBT card occurs automatically when eligibility for the SFSP is approved. The EBT card will be mailed by 3:00 p.m. the following day. The PIN follows in a separate envelope the next day. The card will not be activated until the food stamp benefit recipient calls the CUSTOMER SERVICE NUMBER at 1-800-997 -9999 and verifies his or her identity. Food stamp recipients must also call the CUSTOMER SERVICE NUMBER at 1-800-997 -9999 to report lost, stolen or damaged cards.

In Jefferson County, both the EBT card and the PIN are issued at the DHS county office. Jefferson Coimty issues original EBT cards and replacement cards at the county office. County office persormel provide assistance to the customer with the PIN selection process. The county office also provides training material and, if necessary, a brief orientation of the POS device, the PIN pad, and the printed receipt. If the EBT card is lost or stolen in Jefferson County, the customer must call the CUSTOMER SERVICE

NUMBER at 1-800-997 -9999 to report the problem and then go to the county office to receive the replacement card.

A food stamp recipient may name an authorized representative. If an authorized representative is named, the authorized representative will have a separate card, card number and PIN. The food stamp recipient may choose not to have an EBT card if there is an authorized representative.

Food stamp benefits are available twenty-four hours a day, seven days a week. .Monthly food stamp benefits are credited to the recipient's account at 5:00 a.m. CST on the calendar dates shown below.

LAST DIGIT OF RECIPIENT'S SSN

AVAILABILITY DATE

0-3

5th calendar day of the month

4-6

10th calendar day of the month

7-9

15th calendar day of the month

Cancellation of monthly benefits will occur when the county office receives reliable information that all adult members of the SFSP are deceased or when the entire household has moved irom Arkansas. In other situations, benefits will not normally be canceled after the end-of-month extract.

Cancellation of daily benefits will occur in the Food Stamp Section when the authorized amount is excessive for the household size, when the wrong transaction code is keyed or if the transaction will otherwise cause an imbalance in the accounting process. Benefits may also be canceled in the Food Stamp Section if a keying error has occurred and the county requests the cancellation.

All cancellations, monthly or daily, must be authorized through the Office of Program Planning and Development, Food Stamp Section. (501)682-2448.

An EBT food stamp benefit account does not close when a SFSP case closes. The former recipient remains entitled to the account balance. As long as benefits remain in the EBT food stamp account, the former recipient may still change payees, have cards issued or reissued and select or change PINs.

An EBT food stamp benefit account that is accessed by the cardholder at least once every three months remains an active account. The EBT contractor will notify the State, not the recipient, when an account has not been accessed for 30, 60 and 90 day periods. The

FACTS system will send an automatic notice to the food stamp recipient on the 66ih day to advise the recipient that the account will become aged (inaccessible) unless there is at least one access by the recipient before the 90th day. Benefits in aged accounts may be restored to a food stamp recipient. See TEA 10262 for instructions on restoring benefits.

When a household moves from Arkansas to another state where EBT is not used to issue food stamp benefits or where the state's EBT system will not interact with the Arkansas EBT system, a contractor will issue any remaining food stamp benefits to the household via mail. The EBT Unit in the Central Office will coordinate this issuance.

10261Retroactive Benefits

At the time a food stamp application is approved, food stamp benefits will normally be authorized back to the date of the TEA Cash Assistance application. If the date of appUcation is in a month prior to the month of the TEA Cash Assistance application approval, retroactive food stamp benefits must be authorized for the month (or months) prior to the approval month. Retroactive benefits are subject to proration as explained in TEA 10230. For example, if a food stamp application is submitted on June 23 and approved on August 2, food stamp benefits for the months of June and July will be authorized as retroactive benefits.

To authorize retroactive benefits:

1. Prepare a budget as instructed in TEA 10210 to calculate the amount of food stamp benefits due for the retroactive month or months;
2. Apply proration of benefits as instructed in TEA 10230; and
3. Enter the amount calculated as retroactive benefits in the RETRO fields of the Food Stamp Authorization Document (DCO-233). On the WFSM screen, these are fields 33-34.
10262Restorations and Supplemental Benefits

Supplemental benefits and restored benefits are food stamp benefits issued to a household to correct:

* An error made by the agency;

* An error which occurred in the automated system;

* The failure or inability of the county office worker to process a reported change in accordance with TEA Cash Assistance guidelines.

The distinction between supplemental and restored benefits may be made by considering the month in which the extra food stamp benefits are to be authorized. When the extra benefits are authorized before the end of the month in which the incorrect allotment was originally issued, these benefits are classified as a supplement. When the extra benefits are authorized any time after the end of the month in which the incorrect benefits were originally issued, these benefits are classified as a restoration.

Either supplemental benefits or restored benefits will be calculated by:

1. Preparing a budget as instructed in TEA 10210 to calculate the correct amount of food stamp benefits due;
2. Subtracting the original food stamp benefit amount from the correct amount of benefits due; and
3. Authorizing the supplemental or restored benefit amount via the Automated Adjustment Screen (WFMO) by preparing a Food Stamp Adjustment - Automated 248 System (DCO-248).

See DCOUM 8340 for instructions on authorizing supplemental benefits,

See DCOUM 8370 for instructions on authorizing restored benefits.

NOTE: If a household has an unpaid food stamp overpayment, the amount of restored benefits (BUT NOT SUPPLEMENTAL BENEFITS) must be offset by the amount due on the overpayment. Food stamp benefit overpayments are listed on the WCLM screen. Instructions for offsetting restored benefits may be found in FSC 13320.

10263Recoupments

A household's food stamp benefit amount may be reduced prior to issuance to recover an overpayment. Such action is called "recoupment." A food stamp recoupment can only be applied to a food stamp overpayment.

A recoupment will be initiated against each new overpayment claim processed by the Overpayment Unit if an adult member of the household against which the claim was established is currently certified to receive food stamp benefits. A recoupment will be initiated against the household that.includes the individual in whose name the overpayment was reported and established.

Inadvertent household errors and agency error claims will be recouped at the rate of 10% of the household's monthly benefit amount or $10.00, whichever is greater. Intentional program violation (IPV) claims will be recouped at the rate of 20% of the household's monthly benefit amount or $10.00, whichever is greater.

10300Changes

Households participating in the SFSP will be required to report changes as explained in TEA 4000 - 4440. There are no additional reporting requirements particular to the SFSP. Any change reported to the TEA worker which is effective in the TEA Cash Assistance case must be reflected in the food stamp benefits also.

When a change affects the household's income or household size, a new food stamp budget must be calculated in order to determine the effects of the change on the household's food stamp benefit amount. See TEA 10212 for instructions on calculating a budget. (NOTE: Changes in income disregarded for TEA purposes because they are not significant changes will also be disregarded in the SFSP budget.)

When a household's SFSP benefits change, a notice will be issued to the household. If the household's SFSP case will close or the household's food stamp benefits will decrease as a result of the change, an advance notice of adverse action will be issued to the household. See TEA 10500 for additional information about notice requirements.

10310Households No Longer Entitled to Participate in the SFSP

A household is no longer entitled to participate in the SFSP when:

* The TEA Cash Assistance case is closed; or

* When one or more household members are no longer included in a TEA Cash Assistance case and/or are no longer receiving SSL

When a household is no longer entitled to participate in the SFSP, the household's certification period will be shortened. To shorten a certification period, the new ending certification date must be entered in field 76 of the Food Stamp Master File (WFSM). A Notice of Food Stamp Certification Expiration(DCO-239) will be completed and issued to the household using the local office procedures for NA food stamp applications. A Food Stamp Application(DCO -220) will be enclosed with the DCO-239. The household must receive the DCO-239 on any day during the next to the last month of the shortened certification period. For example, if the certification period is being shortened to end in August, the household must receive a DCO-239 some time during July.

10400Converting Active Cases to the SFSP

When a household is approved to participate in the TEA Cash Assistance Program, the household's records must be examined to determine if there is a food stamp case. If the household is currently participatmg m the regular Food Stamp Program, the food stamp record and the TEA Cash Assistance record will be examined to determine if the household is eligible to participate in the SFSP. See TEA 10100.

If the household is not eligible to participate in the SFSP, no action is required. Food stamp eligibility will continue to be handled through the coimty office's normal procedures.

If the household is eligible to participate in the SFSP, the household's food stamp eligibility will be established under the SFSP. This will not require the submission of a food stamp application. (NOTE; If the household will lose benefits under the SFSP, an advance notice of adverse action must be issued to the household before the reduced allotment becomes effective. See TEA 10500.) The household's certification period will be extended to 12 months if necessary. If the certification period is extended, an application approval must be keyed.

10500Notices

In the SFSP, a Notice of Action (DCO-1) will be issued:

* At initial approval to advise the household of the food stamp benefit amount;

* To notify a household of an impending increase or decrease in the food stamp benefit amount;

* To notify a household of an impending closure of its case; and

* To notify a household when a restored benefit or a supplemental benefit is being issued.

Notices of action issued to advise the household of a decrease in benefits or case closure must be in the form of an advance notice of adverse action. That means the notice must be issued at least ten calendar days before the effective date of the action. Day one of the ten day advance notice period will be the day after the notice is issued. No action will be taken to decrease benefits or to close the case until the ten day period has ended.

Notices of action issued to advise the household of an increase in benefits or the issuance of restored benefits or supplemental benefits must be in the form of an adequate notice. An adequate notice is issued to be received on or before the date the household normally receives its food stamp benefits. (This is the date benefits are normally credited to the household's EBT account. See TEA 10260.)

No notice is required when:

* Ail household members die;

* The household moves from the State; or

* The case is closed at the household's written request.

The notice of action for the SFSP will be combined with the TEA notice of action whenever this is practical.

10600Hearings

Any household whose benefits under the SFSP are adversely affected by an action of the agency must be provided an opportunity to appeal this action through the hearing process.

See TEA 8000 - 8014 for a full explanation of the administrative hearing process.

10700Quality Assurance Reviews

The cases of households participating in the SFSP will be subject to quality assurance (QA) reviews in both the positive and the negative universe. Reviews will be based on the TEA Cash Assistance rules of eligibility. Any SFSP participant who refuses to cooperate in the QA review process will be ineligible to participate in the SFSP until the household cooperates with the QA reviewer or until January 3 of the year following the end of the review period.

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INSTRUCTIONS

TO

DCO-ISO

Application for IVansitional Employment Assistance

Purpose

The DCO-180 is used as the application form for TEA, the Simplified Food Stamp Program (SFSP), TEA Medicaid, and other Medicaid categories. Hie DCO-180 will be used as an application for the regular Food Stamp Program if the TEA applicant is not entitled to participate in the SFSP. Hie form will also be completed to add persons to existing cases in these categories. Also, this form will be &e input document foriegistration and doiial purposes.

Completion

Hie DCO-180 should be completed by Ae applicant/recipient except in the areas designated "For Office Use Only". Only in cases of illiteracy or disability wSudi prohibits completion by the applicant/recipient will the caseworker complete the form. The caseworker will sign as both tiie caseworker ami tiie person helping complete the form in such cases. Any changes or additions made on tills form should be completed by ttie applicant/recipient or the caseworker who originally completed the form.

Only one form will be completed for applications made on a given day. For example, TEA, SFSP, and TEA Medicaid applications made by tiie same application on the same day will require only one form. Once a signed DCO-180 is received and registered, it will not be released to tiie applicant to take home.

For Oflice Use Only

A. Registration

Once the DCO-180 is signed and received by the county, it must be registered. (Page 2 of the DCO-180 contains tiie registration data for registering and denying food stamp applications either under SFSP rules or regular FSP rules. See Item C below.) Only one application can be registered at a time. For applications with multiple categories, all datamust be entered for each registration. The top section designated "For Office Use Only" will be completed as follows:

Field Name Description

Register No Hiese fields will be completed by the terminal operator. Once all registration data has been keyed and accepted, the system will display a register number. If registering multiple applications, list the register numbers in the same order as tiie categories were registered.

Application Date The date (MMDDYY) the signed DCO-180 is received by tiie county.

County The fliree digit county number.

Categoiy The appropriate two digit category code. If registering multiple applications, oiter flie category code for each type of applicatioa

Refer to the DCO-Users Manual for valid categoiy codes.

Adults The number of adults included in Ihe applicatioa

Children Hie number of children included in the applicatioa

Worker # The last four digits of the workei's Social Security number or the assigned worker number.

Worker Name Name of tfie worker whose number is entered in field 8.

MHT If an MRT decision is indicated, enter "Y" otherwise, leave blank as the system will automatically defeultno "N".

Key Dale Completed by the tratninal operator. The date (MMDDYY) information is keyed and accepted by the system.

OP. IN Initials of &e terminal operator keying information into the system.

B. TEA, TEA Medicaid Denials

If the application(s) is to be denied, then the denial section must be completed and forwarded to the terminal operation upon dispositioa If denying more than one application with the same casehead, enter the q}propriate two digit categoiy code in the same order they were entred on the system as indicated in the categoiy field. Each denial code should coincide with &e appropriate categoiy. Refer to the DCO Users Manual for a listing of the denial.

Field Name Description

Worker # The last four digits of the worker's Sodal Security number or the assigned worker number.

Denial Date The effective date (MMDDYY) the application for assistance is being denied.

Reason Two digit denial reasoa Refer to the DCO-Users Manual for Denial Codes and

Reasons.

Categoiy Tlie two digit categoiy code being denied.

CN ClientNotice.

Y - System generated notice specific to Reason (Field 15) will be generated. N - System generated notice will not be generated. Worker will send notice.

Field Name Description

Key Date Completed by the temiinal operator The date (MMDDYY) information is keyed and accepted by the system.

OP INT Initials of the temiinal operator keying infomiation into the system

C. SFSP Registration and Denial

If the DCO-180 is to be used as a food stamp application, dther for tiie SFSP or the regular FSP, page 2 of the DCO-180 will be used to register the food stamp application. If the food stamp application is denied, page 2 of the DCO-180 will be used as the denial document

To register a food stamp application, the following fields must be completed:

Field Name Description

Regi ster # This field will be completed by ttie individual vA\o keys tiie document. Once all registra-

tion data has been keyed via the FACTS Application screen (WFAP) and accepted, the system will display a register number.

Soc. Sec. # Itie Social Security number of the applicant

Appl. Dt The date (MMDDYY) the signed DCO-180 is received by the county.

Key Dt The date (MMDDYY) the application was registered via WFAP.

HH Type One of the following codes;

IN NA (not categorically eligible) 2C PA (categorically eligible)

HH SZ Number of housdiold members.

Type Code A for initial applicatioa

Wkr. # The workernumber of the caseworker.

Op. Int. The initials of the individual who keyed the document

Expedited? Identifies whether the household is entitled to expedited service.

Screener The initials of the worker who screened the application for entitlement to expedited service.

Date The datetheapplicaticmwassaeenedfor entitlement toexpedited service.

LD Date If the housdiold is identified as entitled to expedited service some lime after the applica- tion was filed, the date the late detennination occurred.

Int If a late determination for expedited senice occurs, the initials of die worker wiio made this determinatioa

Denial Date If tiie application is denied, flie date (MMDDYY) on wiiich the denial occurred.

Reason The reason for the denial. Use one of the following codes:

01 Residencenot established
02 Income not verified
03 Other mandatory verification not provided
07 Voluntaiyquit
08 Earned income only-exceeds maximum
09 Income exceeds maximum (combination or other)
10 Resources exceed maximum (real properly)
11 Resources exceed maximum (liquid resources)
12 Resources exceed maximum (vdiicles)
13 Resources exceed maximum (combinalim)
14 Death
15 Moved fi-om stale
16 Refiised to cooperate
17 Missed appointment
18 Other
19 Diq)licate registration
20 Transfer to another county
21 Applicant request

CltNot The client notice indicator. Use one ofdie following codes:

Y System generated notice specific to reason. No notice is generated for codes

18,19,20 and 21. K No system generated notice. Manual notice must be issued either separate fi-om or in combinatitxi with the TEA notice.

Wkr. UThe worker number of the caseworker who authorized the deal.

Op. Int. Tlie initials of the individual who keyed the denial.

D. Extension OfCertincationPeriod

These fields will be used to record when the SFSP certificati(m period was extended. The following information must be completed [GREATER THAN]\henever the SFSP certification is extended:

* Date of contact with household

* Method of contact with household

* Yes checked if the household is still entitled to participate in the SFSP

* No checked if the household is no longer entitled to participate in the SFSP

* Beginning and ending months of the new certification period

* Signature of caseworker who assigned new certification period

Routing and Retention

Fonn DCO-180 will be forwarded upon completion by the worker to the terminal operator If die transaction is accepted on line, the tenninal operator will initial and date the form and return it to the worker. Hie form should then be filed in the case record and retained until the case record is destroyed.

016.20.98 Ark. Code R. 021

7/15/1998