Temporary Assistance/Case Management Manual – Table of Contents

0203.020.00 Signing the Application

IM-75 May 05, 2019

Sections 402 of the Social Security Act provides that the Temporary Assistance (TA) State plan shall allow each individual wishing to apply for assistance be allowed to do so, for whichever programs under the state plan the individual wishes to apply for and to do so without delay.

The Family Support Division requires that applications be made on Family Support Division application forms, and that they are signed under a penalty of perjury.

The following individuals can complete and sign an application for Temporary Assistance:  applicant, legal guardian, conservator, power of attorney, or authorized representative.

 

Signing By a Legal Guardian or Conservator

Obtain documentation of legal guardian or conservator status. If the applicant has a court appointed conservator, instruct the conservator to sign and complete the application. If the applicant has a court appointed guardian, either the guardian or the applicant may sign the application. If an interview is needed, conduct the interview with the guardian or conservator. The applicant’s presence is not required.

In FAMIS, this information is documented on the AUTHREP (FMJ1) screen.

  • Select Sub Program TAC- Temporary Assistance
  • F14= ADDREP- to add a Legal Guardian or Conservator
  • On Representative Detail (FMJG), the following information should be entered:
  • DCN and Name OR DVN and Organization Name
  • Representative Type LGC- For Legal Guardian or Conservator
  • Representative Role APP- Application (For TA, the Legal Guardian and Conservator can apply on their behalf, report changes, and receive notices)
  • PHI(Protected Health Information)- Y or N
  • Begin Date of date of application
  • Address of Legal Guardian or Conservator
  • Phone Number of Legal Guardian or Conservator

 All notices related to the Temporary Assistance application, must be manually sent to the Legal Guardian or Conservator.

 

Signing by an Authorized Representative

An applicant may designate an individual(s) to apply for Temporary Assistance on their behalf. Obtain an IM6-AR for appointment of authorized representative. The authorized representative is recognized by the FSD when a completed Appointment of Authorized Representative IM-6AR form is received. A FSD employee may contact the applicant to verify the written authorization. The IM-6AR form must be signed prior to the Authorized Representative signing the application.

If the applicant has an appointed authorized representative, either the applicant or the authorized representative can sign and complete the application.

The authorized representative may sign the application form, complete and sign the eligibility statement, or complete the FAMIS application interview and sign the interview summary. If further information or documentation is needed, provide a Request for Information (FA-325) form to the authorized representative, and provide a copy of the form to the applicant. Forms that authorize release of information to the FSD such as the Financial Information Request (FA302) form must be signed by the applicant or by the individual in the Eligibility Unit whose information must be verified. The authorized representative has the responsibility to obtain these signed releases as part of the application process.

If needed, an interview may be conducted with the applicant and/or the authorized representative. The applicant’s presence at the interview is not required when an authorized representative has been appointed.

 Multiple Authorized Representatives may be entered.

NOTE:   An applicant who applies on their own may designate an Authorized Representative at any time to assist them in completing the application process.

In FAMIS, this information is documented on the AUTHREP (FMJ1) screen.

  • Select Sub Program TAC- Temporary Assistance
  • F14= ADDREP- to add an Authorized Representative
  • On Representative Detail (FMJG), the following information should be entered:
  • DCN and Name OR DVN and Organization Name
  • Representative Type ARP- For Authorized Representative or ATT- For Authorized Representatives who are Attorneys.
  • Representative Role APP- Application (For TA, the AR can apply on their behalf, report changes, and receive notices )
  • PHI(Protected Health Information)- Y or N
  • Begin Date of date of application
  • Address of Legal Guardian or Conservator
  • Phone Number of Legal Guardian or Conservator

 All notices related to the Temporary Assistance application, must be manually sent to the Legal Guardian or Conservator.

 

0203.020.05 Application with No Signature

If an application is received with no signature and the address of the applicant is known, the application must be returned for signature. Send the original form back to the applicant, legal guardian, conservator, power of attorney or authorized representative for signature with the Signature Request Letter within three business days. If a signed application is not returned, no further action is necessary.

 

Signing By Mark

If the signature is by mark, two witnesses are necessary.

 

Electronic Signature

An electronic signature for web applications is accepted.

NOTE:  An Appointment of Authorized Representative (IM-6AR) or Appointed Protective Payee for TA Benefits (FA-603) form must be signed by the applicant. Relatives cannot appoint an authorized representative on behalf of an applicant. (45 CFR 206.10)

If an application is received with no signature, and the address of the applicant is unknown, keep the unsigned application for 30 days and then destroy after 90 days. Follow ECM Guide Document Triage and Screening on storing the unsigned application.

 

Adding a Person to an Active Case

A signed application is not required to add a person to an active Temporary Assistance case. Although the process for adding a person to an active case is completed in FAMIS by making entries on the Application Request (REQUEST/FM0G) screen, a request to add-a-person is considered an interim change.

As an interim change, mandatory assistance group members must be added to the Eligibility Unit to determine continued eligibility of the assistance group. When an individual is a mandatory member of an existing assistance group, the individual will be considered to be included in the active case as of the date the individual is required to be included in the assistance group.