M E M O R A N D U M

IM-155  10/23/00  IM-41, FORMS MANUAL REV. #36


SUBJECT:
OUT-OF-STATE CLAIMANT INFORMATION REQUEST (IM-41) FORMS MANUAL REVISION #36
 
DISCUSSION:
Attached is a copy of the revised Out-of-State Claimant Information Request (IM-41).  This form revision accommodates the following information needed for the Temporary Assistance Program:
 
  • Month, year and amount of cash grant received
  • Sanctions on any member of the assistance group.
Also included, is the following information needed for the Food Stamp Program:
  • Description of the transfer of property in the last 3 months.
  • Food Stamp benefits received for any non-work months.
  • Any food stamp disqualification on individuals in the household.
  • Conviction of a felony committed after August 22, 1996 related to illegal possession, use or distribution of a controlled substance, violation of probation or parole, or trafficking food stamp benefits.
 
NECESSARY ACTION:
  • Discuss this memorandum with all appropriate staff.

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  • Upon depletion of existing supply, begin using the revised IM-41 form.

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  • Remove form IM-41 dated 04/83 from Forms Manual.

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  • File the revised form in the forms manual.
DC/CSW
Distribution #2
Form not available on line.
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