MEMORANDUM

DISCUSSION:

The purpose of this memorandum is to introduce a new form, Temporary Assistance Drug Testing Applicant Notice (IM-3TADrug). This form is to provide notice to applicants of the drug testing requirements. Effective immediately:

• Begin using the IM-3TADrug form during the required face to face interview for each new TA applicant.
• Review the IM-3TADrug form with the applicant and obtain their signature on the IM-3TADrug form prior to the applicant signing the TA Request for Application (FA-100) and completing the interview.
• Maintain the original signed IM-3TADrug form in the case file.
• Provide a copy of the signed IM-3TADrug form to the applicant.
• Include a copy of the signed IM-3TADrug form as an exhibit if a hearing is scheduled relating to TA drug testing.

Income Maintenance memorandum IM-19 TEMPORARY ASSISTANCE DRUG TESTING dated February 20, 2013, outlined requirements to implement drug testing for the Temporary Assistance (TA) program. Part of those requirements was that FSD staff must ensure all TA applicants sign the Interview Summary (FA-102). Income Maintenance memorandum IM-46 IMPORTANT INFORMATION ABOUT ELECTRONIC BENEFIT TRANSFER (EBT) TRANSACTIONS FORM dated May 7, 2013 added the requirement that the IM-3 EBT form must be signed by all TA applicants. IM-3TADrug is an additional form that must be signed by all TA applicants.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.
• Implement the use of the IM-3TA Drug immediately.

ATTACHMENT:

• Temporary Assistance Drug Testing Applicant Notice (IM-3TADrug)

JKH