Current through Register No. 40, October 3, 2024
(a) An
individual who chooses an authorized representative (AR), as defined in
He-W
601.01(w) , to help with some or all
the responsibilities of applying for or receiving FANF or adult category
financial assistance shall provide all of the following information in writing:
(1) The name, address, and telephone number
of the AR;
(2) The duties that the
AR will carry out, as specified in (c) below;
(3) The individual's relationship to the
AR;
(4) A statement signed and
dated by the individual acknowledging:
a. His
or her responsibility for any errors, omissions, failures to report information
to DHHS, or inaccurate information reported to DHHS by the AR;
b. That if the AR uses the individual's
benefits without permission, these benefits will not be replaced by
DHHS;
c. That the person the
individual names as the AR will continue to act for the individual until the
individual or the AR tells DHHS of a change; and
d. Comprehension of the individual's choice
of AR and the duties assigned to that AR; and
(5) A statement signed and dated by the AR:
a. Agreeing to accept the responsibilities
designated by the individual;
b.
Acknowledging that the AR understands that:
1.
Proof of the AR's identity is required;
2. If disqualified for a program violation,
the person identified as the AR can no longer act as an AR unless there is no
one else suitable to represent the individual; and
3. The AR will continue to act as an AR for
the individual until the AR or the individual tells DHHS of a change.
(b) To
qualify as an AR, an individual shall be an adult who has:
(1) Expressed concern for the individual's
wellbeing;
(2) Sufficient knowledge
about the individual's circumstances to assist the individual in applying for
or receiving assistance; and
(3)
The capability to obtain information about the individual's
circumstances.
(c) The
individual may authorize an AR to carry out one or more of the following
responsibilities:
(1) Obtaining DHHS
applications and other forms or DHHS paperwork, and completing these for the
individual;
(2) Attending
eligibility interviews for the individual;
(3) Providing DHHS with verification of the
individual's income, resources and other case circumstances;
(4) Reporting and verifying changes in the
individual's case circumstances to DHHS;
(5) Receiving the individual's assistance
payment, electronic benefits transfer card, and other DHHS mail;
(6) Asking for, attending, and representing
the individual at administrative appeals for the individual; and
(7) Any other duties regarding eligibility
for financial assistance an individual chooses to designate to an AR.
(d) If designated pursuant to (a)
(2) above, ARs shall:
(1) Sign DHHS forms
completed on behalf of the individual; and
(2) Co-sign DHHS forms they assist the
individual in completing.
(See Revision Note at Chapter Heading He-W 600) #5171,
eff 6-26-91, EXPIRED: 6-26-97
New. amd (g)(5) by #6825, eff
8-3-98; ss by #7182, eff 12-24-99, EXPIRED: 12-24-07
New. #9063, eff
1-5-08
