Application for Assistance Guidebook - North …

1 Application for Assistance Guidebook North dakota department of human services Table of Contents General Information .. 1. Notice of Privacy Practices -- Effective 9-23-13 .. 4. 5. Do Not Share Personal 6. 7. 8. Temporary Assistance For Needy Families (TANF).. 7. 12. Family Violence Screening .. 10. Job Opportunities and Basic Skills (JOBS) Program/Tribal Native Employment Works 14. 15. (Tribal NEW) Program .. 12. TANF Kinship Care .. 14. 16. 17 Child Care Assistance Program (CCAP) .. 17. 18. 20. Crossroads .. 15. Supplemental Nutrition Assistance Program (SNAP) .. 17. 21. Heath Care 20. 24. Medicaid Program .. 21. 25. Medicaid Co-Payments, Services and Limits .. 24 28. 31. Health 26. 32. Emergency Room & Ambulance Services .. 27. Medicaid Managed Care (Primary Care Provider or Managed Care Organization) .. 28 34. Medicare Savings 29. Medicaid 39. 40. Medicaid Estate Recovery .. 30. 42. Healthy Steps Program (Children's Health Insurance Program - CHIP).

2 32. 45. Aid To The Blind-Remedial Program .. 34. 46. Basic Care Assistance Program .. 35. Child Support Enforcement (CS).. (CSE).. 36 47. 50. Quality Control .. 39. 51. Civil 40. Energy Assistance Program (LIHEAP) .. 44. 54. Women Infant & Children (WIC) Program .. 45. 55. 57. 56. Family Planning Program .. 46. 58 58. Community Resources .. 48. 60.. 50. 60. 62 62. Regional Human Service Centers .. 52. 64. General GeneralInformation Information What Whatprograms programs cancanI apply I apply for? for? What What You You programs may programs may apply apply can forfor any can any Iallapply or or Iall apply of of for? these for? these programs programs with with thisthis Application : Application : You You may mayapply apply Temporary TemporaryforAssistance any for or or any allfor Assistance offor all these of these Needy Needyprograms programs Families Families with this with (TANF). (TANF) Application : this Application : Temporary Temporary Temporary Child Child Care Care Assistance Assistance Assistance Assistance for Assistance for for NeedyNeedy Needy Program Program Families Families Families (CCAP).

3 (CCAP) (TANF). (TANF). (TANF). Child Child Child Care Care Care Supplemental Assistance Assistance Assistance Supplemental Nutrition Program Program Program Nutrition Assistance (CCAP). (CCAP). (CCAP). Assistance Program Program (SNAP). (SNAP). Supplemental Supplemental Supplemental Health Health Care Care Nutrition Nutrition Nutrition Coverage Coverage Assistance Assistance Assistance (HCC). (HCC) Program Program Program (SNAP). (SNAP). (SNAP). Health Health Health Aid Care Care Care Aid to to the Coverage Coverage Coverage the (HCC). Blind (HCC). Blind (HCC).. u . Aid Healthy Aid Healthy Aid to to theto Steps thetheSteps Blind (Children's Blind Blind (Children's Health Health Insurance Insurance Program Program CHIP). CHIP).. Medicaid HealthyMedicaid Healthy Healthy u Steps Steps Steps (Children's (Children's (Children's HealthHealth Health Insurance Insurance Insurance Program Program Program - CHIP) - CHIP). - CHIP).. Medicare Medicare Medicaid Medicaid Medicaid u Savings Savings Program Program Basic Basic Care Care Assistance Assistance Program Program (BCAP).

4 (BCAP). Medicare Medicare Medicare u SavingsSavings Savings Program Program Program The Basic The Basic Basic Care Care 'ApplicationCare 'ApplicationForAssistance Assistance Assistance ForAssistance' Program Program Assistance 'Program can can also (BCAP). (BCAP). also(BCAP). be be found foundonline online at at html html or or youyou maymay contact contactyour yourlocal local county county social social service service office officeto to apply apply or or to to request request ananapplication Application byby The The Proof mail. Application Proof mail. Application of of thethe value For valueofAssistance'. ForofAssistance'. current current assetscan assets also can such such beas: also as:befound foundonline online at at or you may contact your local county social service office to apply or to request an or you may contact your local county social service office to apply or to request an Annuities Annuities Life Life Insurance Insurance you Application If Business Application you If need Business need byhelp helpby Accounts mail.

5 Applying applyingforfor Assistance , Assistance , you youmay may have have Real a Real a friend, Property friend, Property relative relative(Land, or (Land, or Rental someone Rental someone Property, else Property, else help help etc.). you etc.). you apply. apply. Certificates Your Certificates Yourlocal localofcounty of Deposit county Deposit social socialservice serviceoffice office cancan also also Saving help help Saving you you Bonds apply Bonds applyforfor Assistance . Assistance . If you If you Checking/Savings/Credit needChecking/Savings/Credit need help helpapplying applying forfor Union UnionAccounts Assistance , Accounts Assistance , youyou may have may Stocks/Bonds/Mutual have aStocks/Bonds/Mutual friend, a friend,relative relativeorFunds Funds someone or someone else else What What do IRA/401K/KEOGH. IRA/401K/KEOGH. doyou you dodo with withplans my plans my information? information? TrustsTrusts help you apply. Your local county social service office can also help you apply for Assistance .

6 Help you apply. Your local county social service office can also help you apply for Assistance . TheThe information information youyou provide provideis held is heldin confidence in confidence andand is used is used solely solely forfor thethepurpose purposeof of program program If only If only administration. applying administration. applying forfor Child Child CareCare Assistance Assistance or or Health Health CareCare Coverage Coverage for for children children andand family family What What do do coverage, you coverage, you youdo do you with dodo withmy notnot need my need information? information? to to report report or or bring bring records recordsof of youryourassets. assets. The information you provide is held in confidence and is used solely for the purpose of The information you provide is held in confidence and is used solely for the purpose of What What information information dodoI need I needtotoprovide? provide? program program Proof Proof ToTo of speed administration.

7 Of speed administration. most most upup current thethecurrent expenses processingexpenses processing of of your such yoursuchas:as: turn Application , Application , turn in with in with your your Application Application or or bring bring to to your your interview interview thethe Child/Dependent Child/Dependent following following items. items. Your YourCareCare worker worker may may bebe ableableto to help help you you obtain obtain these these thingsthings if needed. if needed. What Court Court information What Ordered information Ordered Payments do Payments doI need I need (Child to(Child to Support, Support, provide? provide? Health Health Insurance, Insurance, OtherOther Support). Support). To To Proof Proof Medical speed speed of Medical ofup Alien upthe Alien or orthe or Health or Health processing processing Citizenship Insurance Citizenship Insurance of of your Status Premiums your Status Premiums Application , such (If Application , such asas (If applying applying turn (original turn (original in for in for withSNAP.))))

8 With documents SNAP. your documents only, your only, you Application you Application required required doifdonot ifornot applyingneed or bringneed bring applying to to to provide to provide your your forinterview for Health interview information Healthinformation Care the Care the following for Coverage):for household Coverage): following household items. items. Yourmembers Yourmembers workwork under may under may age bebe age able60. able60 unless to tounless help help they youthey you are are obtain disabled.). obtain disabled.). these these things things if if . needed.. needed. Utility/Shelter Utility/Shelter Resident Resident AlienAlienExpenses Expenses CardCard (Form (If (Form (If applying I-551)applying I-551) for for SNAP). SNAP) Temporary Temporary Resident Resident Card Card (Form (Form I-688). I-688). Employment Heating Employment Heating and andCooling Authorization Cooling Authorization Costs Card Costs Card Property Property Arrival-Departure Taxes Arrival-Departure Taxes Record Record (Form(Form I-94).

9 I-94). (Form . (Form Home I-688A) Home I-688A) Owner's Owner's Insurance Insurance RentRent Passport (Receipt, Passport (Receipt, Lease Lease Agreement, Agreement, Housing Housing Proof Proof Proof ofof of Alien AlienAlien ororor Citizenship Citizenship Citizenship Status Status Status such such such asas as(original (original (original documentsdocuments documents required required required if applyingif if applyingapplying Health American . American House House Payment Indian/Alaskan Payment Indian/Alaskan Native Native Tribal Tribal Document Birth Document Assistance Assistance Birth Certificate Contract). Certificate Contract). (if born (if born in thein the United United States). States). for You for YouHealth Health will be . will be Care Care askedCare Other asked Coverage): Coverage): Other Coverage): to Utility to Utility provide Bills provide Bills information information aboutabout thethe citizcitiz . enshipTelephone Telephone enship or or BillBill status immigration immigration status forforall all persons persons forfor Do whom Do whom I have I.

10 You Resident have Resident you Resident wantto want Alien toprovide Alien to to Alien provide Card receive Card receive Card (Formmy (Formmy Social Assistance (Form Social I-551). Assistance I-551). I-551) Security Security . If. any If any of of theseNumber theseNumber persons persons and and Temporary Temporary Temporary dodo how how Resident notnot is Resident want wantis it Resident used? it Card to to give used? Card give Card (Form (Form (Form information I-688). information I-688). I-688). about about You Proof Proof theirYou their Employment willof will beof most be citizenship most asked citizenship Employment Employment current askedor to Authorization current or provideincome immigration Authorization Authorization income toimmigration provide Social Card (last Social status, Card (last status, Card month Security month Security theytheywilland Numbers and Numbers will not this notbe this (SSNs). be month). (SSNs). eligible Arrival-Departure month).