Current through Register Vol. 48, No. 38, September 20, 2024
a) An
application is a request for cash, medical or SNAP assistance on a Department
of Human Services (Department) form or a DHS web application submitted
electronically that has been completed to the best of the client's knowledge
and ability.
b) The application
must contain a name, address, and signature (or signatures).
1) The Department's application for
assistance captures the electronic signature on a secure directory and places
the electronic signature into a secure database.
2) An electronic signature may be made by an
applicant who checks a box and types his or her name; by an applicant who
telephonically records his or her voice, constituting a telephonic signature;
by an applicant who verbally assents by telephone, constituting a telephonic
signature; or by any other symbol that is executed or adopted, using electronic
means, by the applicant with the intent to authenticate the record. The option
for an applicant to verbally assent by telephone, constituting a telephonic
signature, will end upon the expiration of the COVID-19 Gubernatorial Disaster
Proclamations or the expiration of the federal waiver permitting that option,
whichever occurs first.
3) The
application, which includes the electronic signature, is sent to a secure
database with auditing capabilities that track the user when the application is
modified to ensure the integrity, security and confidentiality of the
electronic signature. This requirement does not apply to applications to which
an applicant verbally assents by telephone.
c) If the application does not contain a
name, address, and signature (or signatures), the local office shall return the
application to the sender to obtain the missing information.
1) If a person is homeless, he or she may use
the address of a friend or relative, supervised shelter, church, halfway house,
or similar facility.
2) If a person
is homeless and does not have a permanent address, he or she may use the
address of the local office where he or she applied or where his or her case is
currently active.
d) The
application must be signed by the applicant with the following exceptions:
1) When a conservator has been appointed for
the applicant, the conservator must sign the application.
2) When the applicant is physically or
mentally unable to sign the application, the application may be signed by
someone acting responsibly on behalf of the applicant.
3) When application is made on behalf of a
child, the child's caretaker must sign the application.
4) When the applicant has appointed an
authorized representative with the Department. (An authorized representative is
a person authorized by the applicant to act on his or her behalf.)
e) Application for medical
assistance may be made on behalf of a deceased person. In order for payment to
be made by the Department for the funeral and burial expenses of the decedent,
the completed application must be received in the local office not more than 30
calendar days after the individual's death, excluding the day on which death
occurred, unless delay in receipt of the form occurred through no fault of the
individual applying.
f) The
applicant may be assisted by the Department and by individuals of the
applicant's choice in completing the application.
g) The date of application shall be the date
a completed application is received by any local office, with the following
exceptions:
1) For applications completed by
pregnant women and children under age 18 at a disproportionate share hospital
or federally-qualified health center, the date the application is signed by the
applicant shall be the date of application.
2) When an application is faxed to a local
office or a web application is submitted and received over the Internet after
5:00 P.M. on a workday, or on a weekend or holiday, the application date is the
next workday following the date the application is received in the local
office.
