APPENDIX F

ARKANSAS DEPARTMENT OF HUMAN SERVICES

FOOD STAMP PROGRAM INTERVIEW GUIDE

I.PURPOSE:

The purpose of this interview guide is to provide a detailed outline for client interviews for the Food Stamp Program. The guide is designed to facilitate a quality interview in terms of thoroughness, accuracy and professional treatment of clients. Throughout each interview the worker will project a positive, yet "caring" attitude.

II.PREPARATION:

.Compare current EMS-220 with two previous EMS-220's.

.Note any changes.

.Check case record for Social Security numbers for all household members.

.Read previous documentation.

.Note any factor which requires verification or further information.

.Be sure client has signed EMS-220.

III.EXPLANATIONS:

.If new applicant, begin with brief explanation of Food Stamp Program in general.

.Explain client's responsibilities for providing complete and accurate information.

.Explain Quality Control.

.Read Penalty Warning.

.Explain our use of SSN's for matching, etc.

.Explain client's right to Fair Hearing, prompt decision, confidentiality of information and Civil Rights.

NOTE:Pages 3 & 4 may be used to assure coverage of these items.

IV.INTERVIEW COVERAGE:

.DO NOT ASSUME THAT YOU ALREADY KNOW ALL ABOUT CLIENT'S CIRCUMSTANCES OR THAT EMS-220 IS COMPLETE AND ACCURATE REFLECTION OF HIS SITUATION.

.ASK ABOUT EVERY ELIGIBILITY FACTOR IN AS MUCH DETAIL AS NECESSARY TO DETERMINE ACTUAL SITUATION. (See Pages 5 though 10 for suggested questions).

.Residency . Identity

.Household Composition . Roomer/Boarder

.Resources . Income

.Students . Medical

.Dependent Care . Shelter/Utilities

.Be sure to review EMS-73 and resolve questionable information.

.Give particular attention to areas noted as changes or as meeting verification or addition information.

V.CONCLUDING THE INTERVIEW:

.Explain to client what additional information is needed to complete application, time frames for providing this, and what happens if it is not provided.

.Review again with client the necessity for complete and accurate information and review the information contained on the EMS-220 just above client's signature.

.Explain in detail client's responsibilities to report changes or Monthly Reporting requirements, whichever is applicable.

.Give client EMS-206, EMS-234, BRM envelope, EMS-1, MR Pamphlet, or any other necessary forms.

.Explain issuances of food stamps by mail, proper use of stamps, what to do if stamps are not received, and approximate time of month stamps can be expected.

NOTE:Pages 10 through 13 may be used to assure coverage of these items.

FS INTERVIEW OPENING

Before your worker begins asking you specific questions about your circumstances, we are required to explain to you your rights and responsibilities as a Food Stamp applicant or recipient. Most of this information is no the application form you have completed, but we need to make sure that we both understand completely.

LET'S BEGIN WITH YOUR RIGHTS:

You have the right to file an application and to receive assistance in completing the necessary forms if you are unable to do so. You have the right to either a decision on your application or an explanation of delay within thirty (30) days.

During the course of your interview, your worker will be asking you a number of personal questions, all of which are necessary to determine your eligibility and the amount of food stamps you will receive. All information you give your worker is confidential and will not be shared with anyone not directly connected with the administration of the Food Stamp Program.

You have the right to receive assistance without regard to age, sex, race, religion, national origin, handicap or political belief. If at any time you feel you have been discriminated against for any of these reasons, you may file a complaint by writing to the address listed on the Food Stamp pamphlet.

You have the right to a written notice of any action we take that will adversely affect your benefits. The notice will explain what action is being taken and the reason for the action. If you disagree with the action being taken, you will find instructions on the back of the notice we send you, telling you how to request a Fair Hearing. You may also make this request in person or by phone to this office. A referee from outside the County office will conduct the hearing to determine if the action being taken is correct. You may be represented at the hearing by an attorney or anyone else you choose.

DO YOU HAVE ANY QUESTIONS ABOUT ANY OF THE INFORMATION YOUR WORKER HAS JUST GIVEN YOU?

NOW LET'S CONTINUE WITH YOUR RESPONSIBILITIES:

Your primary responsibility as an applicant or recipient of food stamps is to provide complete and correct information about your circumstances and to report any changes in this information to this office within ten (10) days. This means you are responsible for answering all questions your worker asks and those listed on the application form completely and accurately with information about everyone in your home, not just yourself. At the end of this interview, your worker will explain in detail what changes you are to report and how to report them.

Failure to give complete, correct information or to report changes will cause you to receive too many or too few stamps. Any stamps you receive, but are not entitled to, will have to be repaid to this agency either in cash or by having part of future Food Stamp benefits withheld.

YOUR RESPONSIBILITIES: Con't.

You are required by law to declare or apply Social Security numbers for everyone in your household. These numbers are used in computer matches with Social Security, Employment Security Division, IRS, and other agency records to identify any earnings or benefits received. These numbers are also used to prevent participation in more than one household at a time, to make mass changes in program reviews and audits.

Your signature on the Food Stamp application form automatically registers all members of your household in the WORK Program. The purpose of the Arkansas WORK Program is to help people receiving food stamps to get a full-time job. All members will be required to participate in the WORK Program unless they meet one of the reasons to be exempt. If you or any member of your household does not cooperate with the WORK Program, they or the whole household, may be disqualified from the Food Stamp Program. Your caseworker will tell you more about WORK Program during the interview.

You should also know that your signature on the Food Stamp application authorizes us to obtain information about you and your household members from banks and savings institutions, employers, federal agencies, including the IRS, and other sources to confirm the accuracy of your statements.

All cases are subject to review for correctness. Cases are reviewed by our computer system, county and state office personnel, Fraud Investigators and both State and Federal Quality Control units. These reviews may include a visit to your home during which you will be interviewed. You should request identification before talking with anyone about your case, but you must cooperate fully with the reviewer in order to continue receiving benefits. The reviewer will determine whether you have correctly reported all information about your circumstances and will also determine whether the county office made any errors in handling your case. If at any time an error by the agency causes you to receive less benefits than you should have, you will receive any additional amounts due you. Likewise, you will be required to repay any benefits you received to which you were not entitled.

Any member of your household who intentionally gives incorrect information or withholds information either when you apply or when changes occur can be barred from the Food Stamp program for 6 months after the first violation, 12 months after the second violation and permanently for the third violation. You can also be fined up to $10,000.00, imprisoned up to five years or both. A court can also bar an individual for an additional 18 months from the Food Stamp program. The individual may also be subject to further prosecution under other federal law.

DO YOU HAVE ANY QUESTIONS ABOUT YOUR RESPONSIBILITIES?

As we begin now and go over the information on your application, be sure to let your worker know if anything has changed since you filled out your form or if there is anything you were not sure about that you may need to add or change so that we will have all of your information absolutely correct.

RESIDENCE (FSC 1300)

Determine that the household is currently living in your county and that you have their correct mailing address. Obtain sufficient directions to the home so that an investigator could find the residence. Verify residence of household at initial application and thereafter when questionable.

1.In what county do you currently live?

2.What is the address where you live? Do you get your mail at your residence address?

3.Where do you pay your property taxes (especially for rural addresses)?

4.Tell me how to get to your house from this office using landmarks, churches, bridges, highway numbers, county road numbers, etc.

5.Have you or anyone else in your home ever received food stamps before? When? Where?

6.Do you or anyone in your home plan to move?

IDENTITY (FSC 1400)

You must verify the identity of the person applying. If the person you are interviewing is an authorized representative, you must verify his/her identity and view verification of the identity of the head of household.

1.Do you have an Arkansas Driver's license or other document to verify your identity?

HOUSEHOLD COMPOSITION (FSC 1600)

Determine everyone who lives or resides in the household, their relationship and living arrangement. Determine the status of citizenship, work registration, Social Security Numbers for all household members, birthdates, whether any household member is aged/disabled. Determine if any person in the home can be classified as a roomer/boarder. Determine from interview and case record if any household member should be disqualified for fraud, Social Security Number requirement, work registration requirements, or whether ineligible due to alien or student status.

1.Please name everyone who lives in the house with you, even if on a temporary basis. (This should be asked even though names are listed on the EMS-220). For new members, when did they move in, where did they come from and relationship.

2.Who is planning to move into or out of your house? When?

3.Who in your home buys food and prepares meals separately from other household members? (If so, determine if eligible for separate household status.)

ROOMER-BOARDER (FSC 1624)

Determine if there is anyone who pays the household for room and/or meals. If so, can this person be classified as a roomer/boarder considering relationship and monetary payments?

1.Who pays you money in order to have a room and food at your house?

2.How much do they pay for food and how much do they pay you for a room? How often do they pay you?

3.How many meals do they eat per day in your household?

RESOURCES (FSC 4000)

Determine all resources at each initial/recertification interview. Resources are assets the household owns or is buying. Examples include money in bank accounts, stocks, bonds, land or houses which the household can sell, and vehicles. (FSC 4600) Some assets are totally excluded (FSC 4400) while other resources may be inaccessible (FSC 4500).

RESOURCE LIMIT:$3,000.00 for all households with aged member regardless of household size.

$2,000.00 for all other households.

EXCEPTIONHouseholds which are categorically eligible do not have to meet resource limits.

1.What cars or trucks does anyone in the home have? Include licensed/ unlicensed and running/not running. If none, how does client get around (office, doctor, grocery, etc.)?

2.Who in home has any of the following: boat, motor, trailer, camper, cycle, 3 or 4 wheeler?

3.What bank or savings and loan do household members use for checking, savings, trusts, C.D.'s, IRA's? If no banks, how do they pay bills?

4.What accounts do child(ren) have (savings, checking, Christmas Club, etc.)?

5.What kind of stocks, bonds, credit union savings/shares do household members have?

6.What do household members have in the way of burial accounts or plots?

7.Does anyone in the household have their name on a bank account, C.D., etc. of someone outside the home? If so, who? What kind of account? How much?

8.What kind of land or buildings does anyone in the household own? Is anyone in the household buying real estate?

9.Is anyone in the household a part owner of any property?

10.What kind of rental property does anyone in the household own?

11.Who in the household owns farm, construction, or shop equipment? (If so, is it essential for self-employment or income producing property?)

12.Has anyone in the household sold, traded, or given away anything of value (land, cars, property)? Ask about installment contracts?

13.Ask client if they have anything on their property that doesn't belong to them.

NOTE:If there has been a divorce, ask about joint property. Also, if client recently moved to the area, ask about bank accounts and property from where they moved.

INCOME (FSC 5000)

Determine and verify what money this household is currently receiving, has recently received and can expect to receive in the future. You must make sure the client understands that cash, contributions, and self-employment are considered income, even if not received regularly. Be aware of potential sources of income based on the client's circumstances, such as interest from savings, HUD assistance, SSI unemployment benefits or Workman's Compensation.

Review the EMS-73 with the client, making sure such expenses as gasoline, tobacco, diapers, medical bills, etc. (which are not specifically listed on the form) are included. Compare the total of expenses to the reported available net income. If expenses exceed income, determine how expenses are being met.

1.Ask who in the home works. How much do they make? How often paid?

2.Ask who in home earns money by working for himself (five examples such as odd jobs, farming, carpentry, babysitting, selling Avon)?

3.Ask client about each household member's last employment, Where? When? Why did he/she leave the employment? Pursue any individual of Voluntary Quit.

4.If a member has recently been working, determine when they last received a paycheck. Verify as necessary.

5.Ask about bonuses and how much paid vacation pay is received and when.

6.Explore any reported source of unearned income and verify (SSA, UI, SSI, W/C, VA, HUD, interest, child support, contributions, etc.)

7.Examine the household's total circumstances and ask specific questions based on what you see as potential income. Examples: Client recently laid off. Is client receiving UI? If not, why not? Client has bank account, does client receive interest? Client receives small SSA. Does client receive SSI? If not, why not?

8.Ask client who else in household receive any money from any other source for any reason.

STUDENTS (FSC 1622)

Determine if anyone in the household meets the definition of a student. If so, determine if the student is eligible or ineligible to participate. Determine if the student's income and resources are included, disregarded or excluded in the Food Stamp budget.

1.Is anyone in the household a student in college or vocational school? Who? Where?

2.How many hours is this student taking this semester? Is this considered full or part time? When does this person plan to graduate? Does the student plan to go to summer school?

3.How does the student pay tuition fees, etc.? How much?

4.What financial assistance does the student receive or has applied for? What period of time is this assistance intended to cover? Are any changes expected in this assistance during the semester/year?

5.Does the student work or participate in Work Study? How many hours per week does he work? Does he participate in JTPA? Is this work self-employment?

6.Who in the household provides the majority of child care for any child(ren) under age six?

7.If you are not married, please explain your living situation. (Example: any other household members and income.)

INELIGIBLE STUDENTS:

1.How are household expenses paid? Divided, vendor, etc.

2.Does the ineligible student deposit money into the same bank account as eligible household member?

MEDICAL (FSC 6500 and 6700)

Determine if anyone in the household is eligible to receive a medical deduction. Determine and verify allowable medical expense when household requests this deduction for those members eligible for medical deduction.

1.Is anyone in the household age 60 or over, or receiving SSI or SSA/RSDI disability?

2.Do these people (identified above) have any medical bills such as doctor, hospital, drugs, glasses?

3.Do you want to provide verification of these bills?

4.What medical insurance do you have? (Include Medicare-Medicaid).

5.Have you received any money from your insurance company for medical costs?

6.What changes do you anticipate in the future in medical costs?

DEPENDENT CARE (FSC 6400)

Determine if household incurs dependent care costs. If so, determine if household is eligible to receive a dependent care deduction.

1.Do you or anyone else in your home pay someone to care for a child or disabled adult in order to work, to look for work, (applicable for WORK Program counties), or go through training for employment?

2.What do you pay for this type of care? How much and how often?

3.What arrangements do you have for child care/dependent care?

SHELTER/UTILITIES (FSC 6600)

Determine allowable shelter costs incurred by the household. Determine if household is entitled to the standard utility allowance. If so, explain the option of choosing between the standard utility allowance and actual utility costs. If household elects to use actual utility costs or is entitled to the standard utility allowance, actual utility costs must be verified if they result in a monthly shelter deduction.

SHELTER

1.Do you pay rent? If so, how much and to whom?

2.Do you own or are you buying your home? If so, how much is your house payment?

3.What type of insurance do you have on your home? (Only allow for structure unless package deal).

4.How much do you pay and how often?

5.What taxes do you pay on your home or land, and how much?

UTILITIES

1.Are you billed for the costs of heating and/or cooling? What is your primary source of heat?

2.What other utilities are you responsible for?

3.Are you responsible for the full amount of these bills?

4.Who helps you pay for utilities (persons or agencies)? How much? How often?

NOTE:Worker should compare medical, dependent care, and shelter-utility costs with the EMS-73.

INTERVIEW CONCLUSION

PENDING APPLICATIONS - Non-MR CASES:

Your worker is going to need some additional information before we can complete your application. The information your worker needs is listed on this form. In order not to miss any benefits that you may be due, be sure to get this information back to your worker by the date shown. Failure to provide this information will cause us to have to deny your application or not allow some deduction.

When your worker has finished processing your application, you will receive a notice by mail telling you what action has been taken, the reason, and if you are eligible, the amount of food stamps you can expect to receive. All food stamps are issued by mail from Little Rock. You should expect to receive the first issuance within five (5) days after receiving your notice. After that, you can generally expect to receive food stamps by the 15th of the month. As soon as the stamps are received, be sure to sign each book and place them in a safe place. We cannot replace stamps lost or stolen after receipt. If, at any time you do not receive your stamps, be sure to notify us before the end of the month.

The stamps you receive are to be used only by you and your household to buy eligible foods. Do not use them to buy tobacco, alcoholic beverages or other non-food items. Do not sell or trade your food stamps or use anyone else's food stamps.

As your worker explained earlier you are required to report all changes within ten (10) days from the date you learn of the change. Your worker will tell you now exactly what you are to report and how to report.

1.Changes totaling more than $25.00 per month in amount, or changes in the source of money received on anyone in your home.

2.Anyone moving into or out of your home.

3.Changes in address and any changes in rent, house payments, or utilities, if you move.

4.Changes in cars or other vehicles owned or being bought by persons in your home.

5.Increases in the amount of cash, bank accounts, or other savings that makes the total you have more than $2,000.00/$3,000.00.

6.Changes in medical expenses of more than $25.00 per month for anyone in your home who is disabled or over 60 years of age.

These changes may be reported in person or by calling the Food Stamp Office. You may also report them by writing a letter or by completing this Change Report Form (EMS-234). A postage-free envelope is also being provided so this can be mailed at no cost to you. In case you forget, the items you are to report are listed in BOLD print on the first page of the Change Report Form.

DO YOU HAVE ANY OTHER QUESTIONS YOU NEED TO ASK?

PENDING APPLICATIONS - MR CASES:

Your worker is going to need some additional information before we can complete your application. The information your worker needs is listed on this form (EMS-206). In order not to miss any benefits that you may be due, be sure to get this information back to your worker by the date shown. Failure to provide this information will cause us to have to deny your application or not allow some deduction.

When your worker has finished processing your application, you will receive a notice by mail telling you what action has been taken, the reason, and if you are eligible, the amount of food stamps you can expect to receive. All food stamps are issued by mail from Little rock. You should expect to receive the first issuance within five (5) days after receiving your notice. As soon as the stamps are received, be sure to sign each book and place them in a safe place. We cannot replace stamps lost or stolen after receipt. If, at any time, you do not receive your stamps, be sure to notify us before the end of the month.

Therefore, it is most important that you complete the form on or after the last day of the month shown at the top as "Budget Month" with all information shown for that particular month. In the income sections, be sure you list all money actually received during that month and attach check stubs or other verification. Be sure that you read and answer each question carefully and completely and that you sign and date the form before mailing in the envelope provided. In addition to completing this report form each month, you need to notify us immediately of any address changes.

DO YOU HAVE ANY OTHER QUESTIONS YOU NEED TO ASK?

ALL APPLICATIONS - Non-MR CASES:

When your worker has finished processing your application, you will receive a notice by mail telling you what action has been taken, the reason, and if you are eligible, the amount of food stamps you can expect to receive. All food stamps are issued by mail from Little rock. You should expect to receive the first issuance within five (5) days after receiving your notice. After that, you can generally expect to receive food stamps by the 15th of the month. As soon as the stamps are received, be sure to sign each book and place them in a safe place. We cannot replace stamps lost or stolen after receipt. If, at any time, you do not receive your stamps, be sure to notify us before the end of the month.

1.Changes totaling more than $25.00 per month in amount, or changes in the source of money received on anyone in your home.

2.Anyone moving into or out of your home.

3.Changes in address and any changes in rent, house payments, or utilities, if you move.

4.Changes in cars or other vehicles owned or being bought by persons in your home.

5.Increases in the amount of cash, bank accounts, or other savings that makes the total you have more than $2,000.00/$3,000.00.

6.Changes in medical expenses of more than $25.00 per month for anyone in your home who is disabled or over 60 years of age.

DO YOU HAVE ANY OTHER QUESTIONS YOU NEED TO ASK?

ALL APPLICATIONS - MR CASES:

When your worker has finished processing your application, you will receive a notice by mail telling you what action has been taken, the reason, and if you are eligible, the amount of food stamps you can expect to receive. All food stamps are issued by mail from Little Rock. You should expect to receive the first issuance within five (5) days after receiving your notice. After that, you can generally expect to receive food stamps by the 15th of the month. As soon as the stamps are received, be sure to sign each book and place them in a safe place. We cannot replace stamps lost or stolen after receipt. If, at any time, you do not receive your stamps, be sure to notify us before the end of the month.

Your household will be required to report your circumstances each month as a condition of continued eligibility. Near the end of each month you will receive a form which you must complete and send to this office along with all required verification such as check stubs, utility bills, etc. This form explains what items must be verified. You will not receive your stamps for the next month until this form and all verification is received and processed by this office. Therefore, it is most important that you complete the form on or after the last day of the month shown at the top as "Budget Month" with all information shown for that particular month. In the income sections, be sure you list all money actually received during that month and attach check stubs or other verification. Be sure that you read and answer each question carefully and completely and that you sign and date the form before mailing in the envelope provided. In addition to completing this report form each month, you need to notify us immediately of any address changes.

DO YOU HAVE ANY OTHER QUESTIONS YOU NEED TO ASK?