2100 Application Process

2110 Initial Requests for Assistance

Requests for financial aid will be made to the Arkansas Department of Human Services office located in the county in which the applicant resides. Application must be made by the applicant himself, by his authorized representative, or by someone acting responsibly for him if the applicant is incompetent or incapacitated.

The agency has the responsibility to follow-up on any request and to make arrangements for completion of the application. Regular AFDC assistance cannot be authorized until the application is approved.

Applications must be made on Form DCO-95 and signed under penalty of perjury. The form advises the applicant of his rights and responsibilities in giving the agency accurate information for determination of eligibility. The application may be introduced as court evidence in fraud cases.

The application shall be registered on the date the signed application form (DCO-95) is received.

Reapplication for financial aid is made in the same manner as initial applications. Previous records shall be reviewed. If the applicant comes from another county where his case was closed for AFDC assistance, the record shall be secured from that county.

2112 Distinction Between Application and Inquiry

Every person has the right to apply for financial assistance. No application or inquiry may be ignored.

Information about coverage, conditions of eligibility, scope, available related services, and rights and responsibilities of applicants/recipients shall be made available to any person requesting such information.

The informational pamphlet entitled "Aid to Families with Dependent Children" will also be given to any person requesting information about the program.

The distinction between an application and an inquiry is as follows:

1. An application is the action by which an individual indicates in writing to the agency administering public assistance his desire to receive assistance. The relative with whom a child is living or will live ordinarily makes application for the child for AFDC.

2. An inquiry is simply a request for information about eligibility requirements for public assistance. An inquiry may be followed by an application.

2120 Initial Contact With Applicant in Person

The applicant, his authorized representative, or, if the applicant is incompetent or incapacitated, someone acting responsibly for him, must be seen in person at the initial contact. The applicant shall be seen at the office or a place of his convenience if he is incapacitated, incompetent, confined, or otherwise incapable of coming to the office.

2130.1 Application Interview

The tasks to be completed during the interview include:

1. Explanation of the AFDC program which will cover the conditions of eligibility, scope and coverage of the program, available related services, and the rights and responsibilities of applicants/recipients. The informational pamphlet entitled "Aid to Families with Dependent Children" must be given to each applicant.
   
2. Explanation that the applicant must assign any rights to support payments to the State and that acceptance of AFDC assistance constitutes such assignment.
   
3. Explanation that unless good cause for refusal to cooperate in child support activities is determined to exist, the Child Support Enforcement Unit shall be notified that AFDC has been granted and the absent parent referred to the CSEU. The applicant shall also be told that unless good cause is determined to exist, the absent parent shall be notified of the assignment.
   

Explanation that the cooperation of the applicant/recipient in child support enforcement activities is a requirement of eligibility unless good cause is determined to exist and that failure to cooperate shall result in the needs of the applicant/recipient not being included in the grant and the payment being provided through a protective payee.

4. Explanation of the responsibility of the agency for carrying out policy in determining eligibility, the responsibility of the applicant for cooperating in the establishment of eligibility, the information needed to establish eligibility and the confidential way in which the agency treats information.
   
5. Explanation of the right of an Administrative Hearing to any applicant who requests a hearing because his application is denied or is not acted upon with reasonable promptness; and to any recipient who requests a hearing because his assistance payment is suspended, reduced, discontinued, or terminated.
   
6. Explanation of the agency time limits for dispensing with applications, and, if eligible, when the applicant may expect money payments.
   
7. Explanation of Family Planning, Food Stamp Program, Service Program, Medical Assistance Program, and the Project SUCCESS Program, if appropriate.
   
8. Explanation and offer of Child Health services. The notice of Availability of Child Health Services (DCO-2650) must be given to the applicant after the Child Health Services program has been explained.
   
9. Explanation of child care assistance which is available to AFDC recipients who are employed or in education or training and who meet certain eligibility criteria. Although provided through Project SUCCESS, this assistance is available to an AFDC recipient even if such person is not a Project SUCCESS participant. PUB-308, "Child Care Assistance", will be given to each applicant after the program has been explained. The designated child care worker's name and phone number will be indicated on the PUB-308.
   
10. Explanation of the AFDC disqualification penalties for committing an AFDC Intentional Program Violation (IPV). An IPV may exist if it is determined by an Administrative Disqualification Hearing or by a Federal or State court that the individual willfully withheld information or reported incorrect information for the purpose of receiving assistance to which he/she was not entitled. (The paragraph concerning Administrative Disqualification Hearings on Form DCO-95 may be reviewed with the applicant).
    
11. Any other tasks specified on the Application Desk Guide which must be completed during the interview.
    
12. Explanation of the right to complete a Voter Registration Application. Refer to Appendix V for Voter Registration policy and procedures.

No person shall be prevented from participation, be denied benefits or be subject to discrimination on the basis of race, color, national origin or handicap. The Agency will be in compliance with provisions of the Civil Rights Act of 1964.

The Agency has the responsibility of informing applicants, recipients, and clients that assistance is provided on a nondiscriminatory basis and of their right to file a complaint with the agency or federal government if it is thought that discrimination has occurred on the basis of race, color, national origin or handicap.

The Service Representative shall secure essential social and financial information to determine eligibility.

The applicant will be relied upon as the primary source of information. However, when the applicant is unable to provide essential information, the Service Representative shall assist in obtaining the necessary verifications. If necessary, the Service Representative shall use Form DCO-81 Consent for Release of Information, to secure essential information from a collateral source. This form must be signed by the applicant/recipient so information may be released to the agency.

If the applicant received assistance and/or services in another county, the closed case(s) shall be requested from the county in which the applicant last received financial assistance and/or services. If the applicant received financial assistance within the preceding 6 months, from another state, the Service Representative shall initiate an OTI directly to the other state, if the information is needed to establish eligibility. The Service Representative must document the interview covering each task completed and record in the narrative and/or on the forms essential social and financial information.

During the initial application interview, the Service Representative shall complete Forms DCO-7, DCO-96, DCO-86, DCO-87 (optional), DCO-115, DCO-1401, if appropriate, and, if necessary, assist the applicant in completing Form DCO-95. Whenever possible the applicant should complete and make any changes or additions on Form DCO-95.

NOTE: If the DCO-87 is not completed and the application is later approved, the Service Representative should use the Worker Alert screen for case record updates, anticipated changes, etc.

The applicant, his legal guardian, or his custodian must sign Form DCO-95.

As a condition of eligibility, all individuals included in the AFDC grant must furnish a Social Security number to the County Office. Applicants and children who do not have an SSN must complete an SS-5 at the County Office to be sent to the Social Security Administration.

The application must be keyed to the Application Data Screen (WIMA) within 24 hours of receipt of the signed DCO-95. The system will assign a register number which must be recorded on the DCO-95.

When the information presented by the applicant or his representative during the first interview establishes that the applicant is ineligible, the application will be denied immediately and no further action is necessary.

When information provided by the applicant indicates emergency need for financial assistance, the application will be considered for immediate action by the Service Representative. In addition, special consideration for immediate action will be given to cases involving child abuse which are identified by the DCFS worker and/or SCAN worker as needing expedited services. The Service Representative shall forward the application to the Economic Services Supervisor or his designated representative with a recommendation for immediate consideration, giving a summary of the reasons.

The case record will be reviewed by the EMS County Supervisor or his designated representative. If the recommendation of the Service Representative is approved by the EMS County Supervisor or his designated representative, the application will be assigned for immediate disposition.

If the application is not accepted for immediate action, the application will be dispensed in regular chronological order.

The Service Representative shall maintain a Control Sheet (DCO-88) of all applications assigned to him for processing. The Service Representative shall list on the Control Sheet:

1. all applications pending at the beginning of the month, arranged by date of application - oldest first;
2. applications assigned to the worker during the month in order of receipt;

As applications are completed, the action and the date of completion will be indicated on the DCO-88.

The Service Representative will inquire into the circumstances of the applicant in order to ascertain the facts supporting the application and to obtain such other information as may be required. This inquiry shall include a home visit before assistance is granted.

When conditions make it impossible to visit the home of the applicant in time to meet urgent needs, assistance may be granted before the home visit provided information required to establish eligibility has been obtained. In such cases, a home visit will be made as soon as possible in order to establish continued eligibility. The home visit requirement may also be waived by the DEMS Director.

The fact that the home visit has been made and additional information acquired to support eligibility will be recorded in the case narrative. The Service Representative will not secure or record in the narrative information already obtained in the initial interview.

The Service Representative will plan with the applicant to secure any additional verifications that are necessary to dispense with the application.

Collateral information is evidence provided by persons other than the applicant or by written documents. (Persons with vested interest in the applicant will not be accepted as collateral sources.) Collaterals will be contacted with the knowledge of the applicant. Specific items requiring such information are so designated in sections dealing with eligibility requirements and methods of inquiry. In order to establish eligibility, collateral information may be obtained to verify statements of the applicant.

If necessary the Service Representative will use Form DCO-81, Consent for Release of Information, to secure essential information from a collateral. This form must be signed by the applicant so information may be released to the agency.

The Service Representative will check records or conduct inquiries by correspondence only when information can best be obtained in these ways. Routine record checking or correspondence which will not likely bring forth additional evidence needed to establish eligibility will be avoided.

The Service Representative will protect the rights of the applicant during collateral interviews and will give only the information necessary to enable the person interviewed to understand the need for the information requested.

When an original, photocopy, or certified copy of a document used as evidence is not a permanent part of the case record, it will be necessary for the narrative to contain definitive information as follows:

1. The location of the document, e.g., where or by whom the document is kept.
2. The pertinent facts contained in the document which establish authenticity, date document was made, where registered or filed, registration or filing identification, serial number, etc.

Conflicting evidence will be resolved.

The Service Representative will have a maximum of 45 days from the date of application to dispose of the application by one of the following actions: approval; denial; withdrawal.

2150.1 County Office

When action on an application has been delayed because of the County Office, the applicant will be notified by the 45th day of the reason for the delay and of his right to an appeal via Form DCO-1.

When action on an application is delayed because information necessary to establish eligibility is needed from the applicant, the Service Representative will notify the applicant via Form DCO-002 (Notice of Delayed AFDC/Medicaid Application) of the specific information needed to establish the applicant's eligibility and the date by which it must be provided. Whenever possible within the application processing timeframes, the applicant will be allowed 10 days from the date of the DCO-002 to provide the information. If less than 10 days is allowed, the applicant must still be given a reasonable time to receive the DCO-002, obtain the information, and return it to the county office. The DCO-002 should be sent as soon as the need for information is known but no later than the 35th day from the date of application.

If the applicant notifies the Service Representative prior to the date specified on the DCO-002 that he is attempting to obtain the information but cannot do so by the specified date, then the Service Representative may allow the applicant additional time to provide the information before denying the application. If additional time is provided, then an DCO-1 will be sent, advising the applicant of the new date by which the information must be provided and that the application will be denied if it is not provided by that date. If the applicant notifies the Service Representative that he is unable to provide essential information, the Service Representative will assist in obtaining the information but the application must be disposed of within 45 days.

The Service Representative will explain to the applicant/recipient the responsibility of reporting changes which might affect eligibility for or the amount of assistance.

1. Age Requirement.
2. Citizenship or Alienage Requirement.
3. Residence Requirements.
4. Deprivation of Parental Care and Support Requirement.
5. Assignment of Rights to Support to the State. (Refer to FA 2246).
6. Cooperation in Child Support Enforcement Activities. (At the point of application, this is shown by the provision of information necessary to the completion of Form DCO-115, if appropriate, unless a claim of good cause is pending determination or hearing decision; please refer to 2248 and 2249.1)
7. Relationship Requirement and Living with Specified Relative.
8. Non-Participation in a strike.
9. Project SUCCESS Requirement. (Refer to FA 2273)
10. Social Security Enumeration Requirement.
11. Need Requirement.

A dependent child must be a needy child who is under the age of 18. AFDC assistance may be continued through the month in which a child reaches age 18.

1. Birth Certificates/Hospital Certificates: Original birth certificates are considered the strongest proof of age. Delayed birth certificates will be accepted. A hospital certificate is also acceptable as proof of age.
   

County staff have on-line access to the Arkansas Department of Health birth records file through the system terminals located in each county office. Birth information from this file may be printed and used to verify age in lieu of an actual birth certificate. Refer to the DCO User's Manual, Appendix M, for detailed instructions on how to access the Health Department file.

If the applicant cannot provide a birth certificate or other acceptable birth verification and the birth information is not on the Health Department file, then Form DHS-47 may be used to obtain an Administrative Copy of an Arkansas birth certificate.

For verification of births out of state, the applicant is responsible for obtaining the necessary verification. If the applicant cannot obtain such verification, the agency may assist by writing the Social Service Agency in the other state to request their assistance in obtaining verification.

2. Government Records: Civil records, court records, draft records, military records, records of the Census Bureau, Social Security records, and other government records may furnish conclusive proof of age.
3. Organization Records: The records of public and private agencies, fraternal societies, organizations such as trade unions, or medical records which give the age or birthdate of an individual will be acceptable evidence of age.
4. School Records: School enumeration records or registration records will be acceptable proof of age if made at the time the child was first registered or at least one year prior to the date of the application.
5. Employment Records: The records kept by an organization or individual who has formerly employed the applicant will be considered acceptable proof of age. This record must be at least 5 years old.
6. License: The applicant may be able to provide a marriage license which will furnish conclusive proof of age.
7. Family Birth Records: Family records of births, marriages, and deaths of members are kept in a permanent register, usually a Bible. For evidence of birth dates for children such a record may be accepted. The condition of entries should show the siblings in the sequence in which they were born.


When a family record is accepted for proof of age, the case record must contain a description of the birth record, the reason the worker decided it was authentic and of long standing, the permanent location of the record, and the date and place it was seen by the Service Representative.

8. Record of Physician: A copy of a birth record of a physician can be accepted as verification.
9. Statement of Witness to Birth: A notarized statement of a witness (such as a doctor, nurse, midwife, or other person present at the time of birth) is acceptable. The following facts must be included:
1. Name of the child and parents.
2. Date and place of birth.
3. Relationship of the witness to the family, such as attending physician or nurse.
4. Facts showing that knowledge is primary and direct, not hearsay.

1. Form I-151 card,
2. Form I-551 card,
3. Form AR-3, or
4. Form AR-103.

Once a DCO-9 declaring citizenship for the adult(s) and children listed on the DCO-95 is obtained, it is not necessary to obtain another declaration for as long as the case remains open unless a new member is added to the case. If the case is closed and the client re-applies, it will then be necessary to obtain a new DCO-9 on all members listed on form DCO-95 and included in the unit.

Any alien granted an indefinite voluntary departure or an indefinite stay of deportation is considered as permanently residing in the United States under color of law. Included among these aliens are Cuban refugees who did not enter at a designated port of entry and therefore were not legally paroled into this country. These and other aliens, although found deportable, may be granted "voluntary departure" for an indefinite period or indefinite stays of deportation because of humanitarian considerations or because of technical difficulties which cannot be overcome and which prevent the Immigration and Naturalization Service (INS) from effecting their deportation.

This section provides for the conditional entry of aliens who because of persecution or fear of persecution on account of race, religion, or political opinion, have fled from a Communist or Communist-dominated country or from the area of the Middle East; or who are refugees from natural catastrophes.

This section provides for the parole into the United States for an indefinite or temporary period, at the discretion of the Attorney General, for emergency reasons in the public interest, of any alien applying for admission. Only parolees admitted for an indefinite period will be considered permanent residents.

Only the alien(s) who is sponsored by the agency or organization will be determined ineligible under this provision. The eligibility of any of the alien's unsponsored dependents will not be affected by the alien's ineligibility.

The disqualification of an "amnesty" or SAW alien does not affect the eligibility of any of such alien's otherwise eligible dependents. The disqualified alien will be excluded from the AFDC assistance unit even if he is an otherwise required member of the Standard Filing Unit. If such alien is the eligible dependent child's sibling, then the alien's income and resources will also be excluded. However, if such alien is the dependent child's parent, then the alien parent's income will be deemed to the assistance unit in the same manner as stepparent income (Refer to FA 2377). Such alien parent's resources will be considered as for any other parent.

Homeless individuals who do not have a fixed or permanent address but reside in the state as residents of Arkansas are eligible for AFDC assistance provided they meet all other eligibility requirements. The county office will determine the address of choice for such applicants. If otherwise eligible, the case may be certified with this chosen address.

To establish eligibility for AFDC, the applicant must provide acceptable evidence that the child is a dependent child according to this definition.

1. The legal father or mother.
2. The legal adoptive father or mother. To be legal adoptive parents the final court decree must have been issued.
3. The natural father of a child born out of wedlock who acknowledges paternity or, whose paternity has been determined by court action, or established by documentation (e.g., birth certificate).
4. Arkansas Status 61-103 provides: "If a man have by a woman a child or children, and afterward shall intermarry with her, and shall recognize such children to be his, they shall be deemed and considered legitimate."

1. must have been unemployed as defined in FA 2241.2 for at least 30 consecutive days prior to the effective date of payment.
2. must have 6 quarters of work within any 13-calender quarter period ending within 1 year prior to application for assistance (FA 2241.3) or received unemployment compensation within the year prior to application (FA 2241.4). For the 6 quarters of work, education may be substituted for up to 4 of the 6 quarters.
3. must not, without good cause, have refused a bona fide offer of employment or training for employment within 30 days prior to receipt of assistance (FA 2241.5).
4. must not have refused to apply for or accept unemployment compensation if qualified (FA 2241.6).

The Service Representative will total the earnings of each parent to determine which parent has been the principal wage earner. If both parents earned an equal amount of income or there was no income for the 24-month period, the clients will be given the option of which parent will be designated as the PWE. If the clients cannot make a choice, the Service Representative will designate which parent will be the principal wage earner. The Service Representative will document on forms EMS 16 and EMS-96 which parent is considered to be the principal wage earner.

  1. The principal wage earner is not employed or is employed less than 100 hours a month; or

For self-employed persons, the eligibility worker may accept a written statement verifying the number of hours that are devoted to the self-employment enterprise per month. This written statement may be used to determine unemployed status.

The PWE must have 6 quarters of work within any 13-calendar quarter period ending within 1 year prior to application for assistance, or received unemployment compensation within the year prior to application. For the 6 quarters of work, education may be substituted for up to four quarters of work.

Example 5: 1986     1987      1988     1989     1990
                    1 2 3 4/ 1 2 3 4/ 1 2 3 4/ 1 2 3 4/ 1 2 3 4
                    $ 1000 - $ $ $ $ $

Using the above diagram, the application month is October 1990. The 13-calendar quarter period being reviewed is the fourth quarter, 1986 through the fourth quarter, 1989. In this period, the PWE has earnings of $50 or more in the 1st, 2nd, 3rd and 4th quarter of 1987 and in the 1st quarter of 1988. He had no earnings in the 4th quarter of 1986, but had earned $1000 in the first 3 quarter of 1986. Since these earnings qualify as 2 "quarters of coverage" for 1986 (1000¸440=2) and the 13 calendar quarter period begins in 1986, 1 "quarter of coverage" for 1986 may be used to meet the 6 quarters.

Example 6: The PWE's month of application is October, 1990. The thirteen calendar quarter period being reviewed is the third quarter, 1987 through the third quarter, 1990.

The Service Representative will document on form EMS-16 how the "quarters of work" requirement was met by the PWE. Acceptable types of verification for work history include, but are not limited to WESD screen, check stubs, statements from former employers, self-employment wage records, W-2 forms, income tax returns, and ESD records. To verify school attendance, the Service Representative will request a statement from the school or school records showing dates attended and full-time status.

Receipt of UI may be verified using the WESD Screen. The recipient may also provide verification from ESD, if the WESD screen does not reflect payment.

Prior to denying or terminating assistance under this section, the Service Representative must determine that an offer of employment at the applicable federal or state minimum wage or at a wage customary for such work in the community was actually made before determining good cause. Offers made through the Employment Security Division of Manpower agencies will be verified with that agency. The parent will be given the opportunity to provide good cause for not accepting employment.

1. The person is ill, incapacitated or age 60 or older.
2. No reasonable means of transportation is available to and from the job site.
3. The working conditions would be a risk to the person's health and safety.

If the PWE refuses to apply for or accept Unemployment benefits, the application for assistance will be denied or if it is an ongoing case, it will be closed. Filing weekly claims is a part of the application process. Failure to submit claims for any week that the recipient is eligible is considered a "refusal to accept UI benefits".

The alleged death of a parent will be verified.

1. An earning rate comparable to that which was earned prior to the onset of the disability; and
2. The range of jobs in the parent's usual occupation; the performance of all of which may be necessary to the production of the former earning rate; or
3. That the parent is unable to perform the usual household duties or provide normal care for the children.

Please note that deprivation may be based on absence due to illness only when the parent is actually hospitalized. If the parent has already returned to the home prior to an eligibility determination having been made for the other family members, then assistance may not be authorized based on the parent's hospitalization even if the parent is recuperating at home. In that situation, a disability decision from MRT finding the parent eligible must be received before assistance for any of the children may be authorized.

If either parent is receiving treatment and/or training under Rehabilitation Services, incapacity must be established in the normal manner.

1. In the parent has been a patient in a private, State or Federal hospital, Veterans Hospital, or the University of Arkansas Medical Center within the past year (the past five years for the Arkansas State Hospital) complete Form EMS-81 (Consent for Release of Information). A separate form must be completed for each institution. Information from these institutions will be obtained by the Medical Review Team. (Form EMS-107 should never be sent to an institution.)
2. If the parent has not been hospitalized within the past year, Form EMS-107 (Confidential Report of Medical Examination of Patient) must be completed. If the patient's disability involves visual acuity Form EMS-701 shall be completed instead of Form EMS-107. Form EMS-107 or EMS-701 may also be completed by a parent who has been hospitalized within the past year, if the parent so chooses, to provide medical information in addition to that which will be obtained from the institution(s).


If Form EMS-107 is used, the Service Representative shall complete all identifying information in Part 1. The parent must sign the form in Part 2. The form will then be given to the parent to take to his choice of a medical practitioner who is qualified to provide information on the particular condition to substantiate the parent's claim of incapacity.

If Form EMS-701 is used, the County Office will complete the identifying information and provide the recipient with three copies of form to take to an opthamologist or optometrist of his choice. A stamped envelope addressed to the County Office will be provided with the form. The practitioner must complete the remainder of the form and return the form to the County Office. Information provided on Forms EMS-107 and EMS-701 is confidential and shall not be released to anyone, including the parent, by the County Office.

3. The parent may also submit, if available, additional written medical reports from medical practitioners or other qualified professionals providing care for the parents' physical and/or mental condition to supplement Form EMS-107, EMS-701, or EMS-81.
4. Complete Form EMS-108 (Social Report). This report is necessary for all cases submitted to the Medical Review Team.
5. Attach to the completed EMS-108, the completed EMS-107 or EMS-701 and/or EMS-81, any additional medical evidence submitted by the parent, and any medical information (such as Rehabilitation Services or CCS reports) on file in the County Office, and mail to the Central Office, Medical Review Team.

If MRT finds that the medical information is not adequate to make a decision, further medical, psychiatric, or psychological examinations will be recommended by MRT at the expense of the agency. Arrangements for such evaluations will be made by MRT only.

The Arkansas Rehabilitation Services Division is the major rehabilitation resource in Arkansas. Referrals for Rehabilitation Services shall be made via Form DHS 3300. Referrals to other agencies will be made via Form DHS-3300, if appropriate, or by letter or established written communication.

If a re-application is filed and the case has been closed within the past five years for reasons other than disability and the last EMS-109 stated "Re-examination not necessary" or the date for re-examination has not yet been reached, new medical and social information will not be submitted to MRT. If the case has been closed for more than five years, new medical and social information will be submitted to MRT unless the parent is receiving SSI or OASI based on disability, or is age 70 or older.