M E M O R A N D U M

IM-115  09/17/02  60-MONTH LIFETIME LIMIT FORM AND INSTRUCTIONS
FORMS MANUAL REVISION #25:  NOTICE OF TEMPORARY ASSISTANCE
EXTENSION FOR HARDSHIP ACTION (IM-363)


SUBJECT:
60-MONTH LIFETIME LIMIT FORM AND INSTRUCTIONS
FORMS MANUAL REVISION #25:  NOTICE OF TEMPORARY ASSISTANCE EXTENSION FOR HARDSHIP ACTION (IM-363)
DISCUSSION:
Income Maintenance Memorandum IM-83 dated July 3, 2002, and IM-92 dated July 18, 2002 referenced new forms to be used in the evaluation process for extending a family's 60-month lifetime limit due to a hardship.

The following form and instructions are attached:

  • Notice of Temporary Assistance Extension for Hardship Action (IM-363)
This form will be sent to county offices in an initial distribution.  Staff will be notified when the template is available to download.

Do not use the IM-363 with a revision date of 05/02 presented during training.
NECESSARY ACTION:
  • Review this memorandum with appropriate staff.

    •  
  • Review IM-83 and IM-92 for use of the form.

    •  
  • Destroy all IM-363's with a revision date of 05/02.

    •  
  • File the IM-363 (pdf) with a revision date of 07/02 and the instructions (pdf) in the Forms Manual.

    •  
  • Add the above forms to the Forms Manual Table of Contents by pen and ink changes.

    •  
  • Immediately begin using this form to notify participants of their eligibility for an extension based on hardship.
DC/GZ
Distribution #6
IM-114
[ 2002 Memorandums ]
 IM-116