STATE OF NEW HAMPSHIRE
INTER-DEPARTMENT COMMUNICATION
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DATE: |
September 17, 1996 |
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FROM: |
OFFICE OF THE ASSISTANT COMMISSIONER |
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AT (OFFICE): |
Division of Human Services Office of Economic Services |
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SUBJECT: |
Release of Revised Form 77c, New Hampshire State Supplement Program, and Release of Form 77c(i) |
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TO: |
ALL REGIONAL ADMINISTRATORS ATTENTION: OES Supervisors |
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Effective Date: |
September 30, 1996 |
SUMMARY
This SR revises Form 77c, New Hampshire State Supplement Program, and releases Form 77c(i) for the first time.
POLICY
Form 77c, New Hampshire State Supplement Program, is an informational pamphlet which is given to state supplement applicants when they apply for financial assistance under the Old Age Assistance (OAA), Aid to the Permanently and Totally Disabled (APTD) or Aid to the Needy Blind (ANB) program.
Form 77c has been revised to include changes in terminology which reflect the reorganization of the Department of Health and Human Services. References to the Division of Human Services have been changed to the Department of Health and Human Services. Also, the section of the form entitled, "What is Reimbursement/Recovery?" has been revised to address the reimbursement and lien policy for OAA and APTD financial assistance cases. This section previously addressed liens for medical assistance only clients in great detail. Since this is a state supplement pamphlet, it was determined that the elaboration on liens on MA only clients was unnecessary.
IMPLEMENTATION
District Offices may continue using current supplies of Form 77c until the revised versions are received from printing. It is anticipated that they will arrive towards the end of September.
CLIENT NOTIFICATION
No special client notification is planned due to the changes in this pamphlet. District Offices will continue to provide state supplement applicants with this pamphlet at application.
TRAINING
No training is planned due to the procedural nature of this SR.
POSTING INSTRUCTIONS
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Remove and Destroy |
Insert |
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Forms Manual |
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Form 77c, |
Form 77c, |
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SR 96-05/April 1996, |
SR 96-50/September 1996, |
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1 sheet |
1 sheet |
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None |
Form 77c(i) |
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SR 96-50/September 1996, |
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1 sheet |
DISPOSITION
This SR may be destroyed after its contents have been noted and its posting instructions carried out.
DISTRIBUTION
This SR will be distributed according the SR narrative distribution list. Printed copies of the form and its instructions will be distributed to all holders of the Forms Manual.
OES/SJC/s
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CERTIFICATE OF DESTRUCTION
I certify that all copies of Form 77c, SR 96-05/April 1996 have been destroyed.
Office Manager __________________________ District Office________________________
Please return this to Stock Control after revised copies of Form 77c, SR 96-50/September 1996 have been received in the District Office.