INTERVIEW GUIDE FOR RIGHTS AND RESPONSIBILITIES SNAP ONLY CASES - Indiana

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INTERVIEW GUIDE FOR RIGHTS AND RESPONSIBILITIES SNAP ONLY CASES (For Internal DFR Staff Use Only) The following information is being provided as a summary of your rights and responsibilities. You received a copy of the complete rights and responsibilities at the time you applied for benefits. Please be sure to read your copy of the rights and responsibilities over carefully and ask a worker if you have any questions. You have a right to equal treatment without regard to race, color, age, sex, disability, national origin, religious or political beliefs. You have a right to receive information about any Division of Family Resources (DFR) programs, to have your application processed promptly, and information kept confidential unless directly related to the administration of programs. You also have a right to obtain help from DFR with your application, to reapply if your benefits stop and to have a fair hearing if you disagree with action DFR takes on your case. Getting benefits from the DFR means you have responsibilities too. Remember to be truthful on your application and during your interview. At any time, government officials, investigators and/or Quality Control will be checking your information. Your cooperation is requested if they review your case. If we find that you knowingly provided false information, your benefits may be denied or cancelled. You can be fined or criminally prosecuted under Federal or State laws. If you received benefits to which you are not entitled, you will have to pay DFR back. DFR can intercept your tax refunds, Social Security or turn the claim over to a collection agency. To avoid all of this, you must be truthful to the best of your knowledge. You must also agree to provide: Documents to confirm information on your application and information you provided at your interview. A social security number for each person whom you want to receive benefits. A statement and/or documentation that each person receiving benefits is a U.S. citizen or an alien in lawful status. By signing the application you have given permission for DFR to share your information with other federal, state and local officials. We will use your information, including your Social Security Number to match information and benefits from other service agencies, such as: Social Security Administration Internal Revenue Service Indiana Department of Revenue Indiana Department of Workforce Development You need to know that what we learn about you may affect your eligibility and benefits. SNAP households are subject to simplified reporting requirements. This means you are required to report when your gross monthly income exceeds the gross monthly income guideline for your household size. The monthly income limit is included in the notice of eligibility. To be considered timely, Effective April 2018 1Internal DFR Staff Use Only

the change must be reported by the 10th day of the next month. You can report changes by calling 1800-403-0864, going into the local office, by mail, fax or online. Anyone convicted of a drug felony after August 22, 1996 or fleeing to avoid prosecution of a felony conviction is not eligible to receive SNAP benefits. Also know that we will provide your information to law enforcement if necessary to apprehend someone fleeing the law or in violation of probation or parole. If an individual voluntarily quits a job, or voluntarily reduces work hours, without good cause or is terminated from a job for disciplinary reasons, it may affect your eligibility or the amount of benefits you receive. If you are not part of an assistance group with a child under age 18, are able-bodied, and between the ages of eighteen (18) and forty-nine (49), you may receive SNAP benefits no longer than three (3) months unless you: Work at least twenty (20) hours per week on average each month; or Participate in a Job Program approved by the Family and Social Services Administration at least twenty (20) hours per week; or Meet one of the exemptions; or Participate in a Community Work Experience Program (CWEP) activity. If you have lost eligibility after receiving SNAP benefits for three (3) months, you may regain eligibility by: Working at least eighty (80) hours in a thirty (30) day period; or Participating at least eighty (80) hours in a thirty (30) day period in an approved Job Program; or Meeting one of the exemptions If you are determined to be exempt from work registration, you may always volunteer to receive employment and training services through IMPACT. If you are eligible for SNAP benefits, you will use a Hoosier Works EBT Card to buy groceries. Here are some rules that must be followed: Do not sell or trade your SNAP benefits or Hoosier Works card. Do not use someone else’s SNAP benefits for your own personal gain. Do not use your card to buy alcohol, tobacco, drugs, firearms, ammunition, explosives, or non food items. If you break these rules, you can lose your benefits, be fined, or be prosecuted for trafficking. Our rules are important to make sure benefits go only to the people who are truly eligible for them. We appreciate your patience and cooperation. We want to help you and be fair. If you choose not to provide information, we understand, but benefits may be denied. Effective April 2018 2Internal DFR Staff Use Only

INTERVIEW GUIDE FOR RIGHTS AND RESPONSIBILITIES FOR COMBINED SNAP AND TANF CASES (For Internal DFR Staff Use Only) The following information is being provided as a summary of your rights and responsibilities. You did receive a copy of the complete rights and responsibilities at the time you applied for benefits. Please be sure to read your copy of the rights and responsibilities over carefully and ask a worker if you have any questions. You have a right to equal treatment without regard to race, color, age, sex, disability, national origin, religious or political beliefs. You have a right to receive information about any Division of Family Resources (DFR) programs, to have your application processed promptly, and information kept confidential unless directly related to the administration of programs. You also have a right to obtain help from DFR with your application, to reapply if your benefits stop and to have a fair hearing if you disagree with action DFR takes on your case. Getting benefits from the DFR means you have responsibilities too. Remember to be truthful on your application and during your interview. At any time, government officials, investigators and/or Quality Control will be checking your information. Your cooperation is requested if they review your case. If we find that you knowingly provided false information, your benefits may be denied or cancelled. You can be fined or criminally prosecuted under Federal or State laws. If you received benefits to which you were not entitled, you will have to pay DFR back. If you do not repay, DFR can intercept your tax refunds, Social Security or turn the claim over to a collection agency. To avoid all of this, you must be truthful to the best of your knowledge. You must also agree to provide the following: Documents to confirm information on your application and information you provided at your interview. A social security number for each person whom you want to receive benefits. A statement and/or documentation that each person receiving benefits is a U.S. citizen or an alien in lawful status. By signing the application you have given permission for DFR to share your information with other federal, state and local officials. We will use your information, including your Social Security Number to match information and benefits from other service agencies, such as: Social Security Administration Internal Revenue Service Indiana Department of Revenue Indiana Department of Workforce Development You need to know that what we learn about you may affect your eligibility and benefits. SNAP households are subject to simplified reporting requirements. This means you are required to report when your gross monthly income exceeds the gross monthly income guideline for your household size. The monthly income limit is included in the notice of eligibility. To be considered timely, Effective April 2018 3Internal DFR Staff Use Only

the change must be reported by the 10th day of the next month. You can report changes by calling 1800-403-0864, going into the local office, by mail, fax or online. Anyone convicted of a drug felony after August 22, 1996 or fleeing to avoid prosecution of a felony conviction is not eligible to receive SNAP benefits. Also know that we will provide your information to law enforcement if necessary to apprehend someone fleeing the law or in violation of probation or parole. If an individual voluntarily quits a job, or voluntarily reduces work hours, without good cause or is terminated from a job for disciplinary reasons, it may affect your eligibility or the amount of benefits you receive. If you are not part of an assistance group with a child under age 18, are able-bodied, and between the ages of eighteen (18) and forty-nine (49), you may receive SNAP benefits no longer than three (3) months unless you: Work at least twenty (20) hours per week on average each month; or Participate in a Job Program approved by the Family and Social Services Administration at least twenty (20) hours per week; or Meet one of the exemptions; or Participate in a Community Work Experience Program (CWEP) activity. If you have lost eligibility after receiving SNAP benefits for three (3) months, you may regain eligibility by: Working at least eighty (80) hours in a thirty (30) day period; or Participating at least eighty (80) hours in a thirty (30) day period in an approved Job Program; or Meeting one of the exemptions If you are determined to be exempt from work registration, you may always volunteer to receive employment and training services through IMPACT. If you are eligible for SNAP benefits, you will use a Hoosier Works EBT Card to buy groceries. Here are some rules that must be followed: Do not sell or trade your SNAP benefits or Hoosier Works card. Do not use someone else’s SNAP benefits for your own personal gain. Do not use your card to buy alcohol, tobacco, drugs, firearms, ammunition, explosives, or non food items. If you break these rules, you can lose your benefits, be fined, or be prosecuted for trafficking. In order to be eligible for TANF cash assistance, you must do the following: Cooperate in creating a plan to help get you back to work. Participate in work-related activities, designed to assist you with employment and training. Provide proof of current immunizations for children. There are few exceptions. Ensure all school-aged children maintain regular school attendance. Cooperate in assigning child support rights to the Indiana Child Support Bureau Cooperate in identifying any absent parents Cooperate in establishing paternity and court ordered child support. There can be exceptions. Also to receive TANF you must turn over to the Indiana Child Support Bureau payments for child support, spousal support and cooperate with Child Support Enforcement staff. Effective April 2018 4Internal DFR Staff Use Only

Anyone convicted of a drug felony after August 22, 1996 is not eligible to receive TANF for ten (10) years from the date of conviction. Anyone found to be fleeing to avoid prosecution of a felony conviction is ineligible. Also know that we will provide your information to law enforcement if necessary to apprehend someone fleeing the law or in violation of probation or parole. While receiving TANF benefits, you must report all changes in your household circumstances to DFR within 10 days. You can report changes by calling 1-800-403-0864, going into the local office, by mail, fax or online. Once you are determined eligible for TANF benefits, you will use a Hoosier Works EBT card to make cash withdrawals and purchases. You must follow these rules in the use of your card: Do not sell or trade your card or use someone else’s card Do not use your card at liquor stores, gambling establishments, horse racing facilities, gun stores or adult entertainment establishments. If you choose not to cooperate, or follow any guidelines, the TANF benefits for your entire household may be denied, reduced, or discontinued. And a final, very important, point: TANF is temporary. The receipt of TANF cash benefits is limited to a total of 24 months for adults who are mandatory for Indiana’s employment and job training program and 60 months for their families. The 60 months includes TANF benefits received in Indiana as well as other states. In that time, DFR will work with you to help you and your family. We can do it, but we need your help. Effective April 2018 5Internal DFR Staff Use Only

INTERVIEW GUIDE FOR RIGHTS AND RESPONSIBILITIES FOR TANF ONLY CASES (For Internal DFR Staff Use Only) The following information is being provided as a summary of your rights and responsibilities. You did receive a copy of the complete rights and responsibilities at the time you applied for benefits. Please be sure to read your copy of the rights and responsibilities over carefully and ask a worker if you have any questions. You have a right to equal treatment without regard to race, color, age, sex, disability, national origin, religious or political beliefs. You have a right to receive information about any Division of Family Resources (DFR) programs, to have your application processed promptly, and information kept confidential unless directly related to the administration of programs. You also have a right to obtain help from DFR with your application, to reapply if your benefits stop and to have a fair hearing if you disagree with action DFR takes on your case. Getting benefits from the DFR means you have responsibilities too. Remember to be truthful on your application and during your interview. At any time, government officials, investigators and/or Quality Control will be checking your information. Your cooperation is requested if they review your case. If we find that you knowingly provided false information, your benefits may be denied or cancelled. You can be fined or criminally prosecuted under Federal or State laws. If you received benefits to which you are not entitled, you will have to pay DFR back. DFR can intercept your tax refunds, Social Security or turn the claim over to a collection agency. To avoid all of this, you must be truthful to the best of your knowledge. You must also agree to provide the following: Documents to confirm information on your application and information you provided at your interview. A social security number for each person whom you want to receive benefits. A statement and/or documentation that each person receiving benefits is a U.S. citizen or an alien in lawful status. By signing the application you have given permission for DFR to share your information with other federal, state and local officials. We will use your information, including your Social Security Number to match information and benefits from other service agencies, such as: Social Security Administration Internal Revenue Service Indiana Department of Revenue Indiana Department of Workforce Development You need to know that what we learn about you may affect your eligibility and benefits. In order to be eligible for TANF cash assistance, you must do the following: Cooperate in creating a plan to help get you back to work. Participate in work-related activities, designed to assist you with employment and training. Provide proof of current immunizations for children. There are few exceptions. Effective April 2018 6Internal DFR Staff Use Only

Ensure all school-aged children maintain regular school attendance. Cooperate in assigning child support rights to the Indiana Child Support Bureau Cooperate in identifying any absent parents Cooperate in establishing paternity and court ordered child support. There can be exceptions. Also to receive TANF you must turn over to the Indiana Child Support Bureau payments for child support, spousal support and cooperate with Child Support Enforcement staff. Anyone convicted of a drug felony after August 22, 1996 is not eligible to receive TANF for ten (10) years from the date of conviction. Anyone found to be fleeing to avoid prosecution of a felony conviction is ineligible. Also know that we will provide your information to law enforcement if necessary to apprehend someone fleeing the law or in violation of probation or parole. While receiving TANF benefits, you must report all changes in your household circumstances to DFR within 10 days. You can report changes by calling 1-800-403-0864, going into the local office, by mail, fax or online. Once you are determined eligible for TANF benefits, you will use a Hoosier Works EBT card to make cash withdrawals and purchases. You must follow these rules in the use of your card: Do not sell or trade your card or use someone else’s card Do not use your card at liquor stores, gambling establishments, horse racing facilities, gun stores or adult entertainment establishments. If you choose not to cooperate, or follow any guidelines, the TANF benefits for your entire household may be denied, reduced, or discontinued. And a final, very important, point: TANF is temporary. The receipt of TANF cash benefits is limited to a total of 24 months for adults who are mandatory for Indiana’s employment and job training program and 60 months for their families. The 60 months includes TANF benefits received in Indiana as well as other states. In that time, DFR will work with you to help you and your family. We can do it, but we need your help. Effective April 2018 7Internal DFR Staff Use Only

The following information is being provided as a summary of your rights and responsibilities. You did receive a copy of the complete rights and responsibilities at the time you applied for benefits. Please be sure to read your copy of the rights and responsibilities over carefully and ask a worker if you have any questions.

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