New Hampshire Code of Administrative Rules
He - Department of Health and Human Services
Subtitle He-W - Former Division of Human Services
Chapter He-W 600 - FINANCIAL ASSISTANCE AND ELIGIBILITY FOR MEDICAL CARE
Part He-W 606 - VERIFICATION
Section He-W 606.104 - Verification Requirements for Emergency Assistance
Universal Citation: NH Admin Rules He-W 606.104
Current through Register No. 40, October 3, 2024
(a) The following general verification requirements shall apply to any client requesting emergency assistance:
(1) Clients
shall provide the documentation in (b) below of their emergency situation
within 10 calendar days of their request for emergency assistance. Failure to
provide the required verification shall result in denial of the emergency
assistance request;
(2) Clients
shall provide documentation indicating the amount of assistance necessary to
cure the emergency situation;
(3)
Clients shall provide documentation of the personal property resources, as
defined in
He-W 699.05,
owned by the assistance group;
(4)
For utility deposits, utility arrearages, and deliveries of home heating fuel,
the client shall provide documentation indicating that energy assistance funds
are not available to meet the emergency need;
(5) For deliveries of home heating fuel, the
client shall provide documentation from the fuel delivery company indicating
that payment of the current delivery and/or the arrearage amount at his or her
current or past residence will allow a current fuel delivery; and
(6) Clients shall provide additional
documentation indicating that the payment authorized by the department shall
cure the emergency situation, if the amount of the emergency need exceeds the
maximum emergency assistance provided by the department, as specified in
He-W
699.05.
(b) Acceptable documentation shall be:
(1) A bill, rental agreement, or other
document signed and dated by the landlord indicating the amount of the security
deposit;
(2) A bill, or signed and
dated statement provided by a representative of the utility company indicating
the amount of the utility deposit;
(3) One of the following, if the amount of
the security deposit, utility deposit, home heating fuel delivery, or
employment related barrier item is greater than the maximum allowed by the
department, as defined in
He-W 699.05,
plus the client's personal property resources, as defined in
He-W 699.05:
a. A signed and dated statement from an
outside source indicating that it shall provide the remainder of the deposit,
home heating fuel cost, or employment related barrier cost;
b. A signed and dated statement from the
landlord, utility company, home heating fuel company, or provider stating that
the payment authorized by the department shall secure the housing, utility,
home heating fuel, or provide the employment related barrier item; or
c. Documentation that a payment plan has been
arranged for the remainder of the deposit, home heating fuel cost, or
employment related barrier cost;
(4) A termination notice, a bill, or
statement from the utility company indicating the amount of the utility
arrearage;
(5) One of the
following, if the amount of the back rent, mortgage principal and interest, or
utility arrearage exceeds 2 months:
a. A
signed and dated statement from the landlord, mortgagee, or utility company
indicating that payment of a 2 month portion of the arrearage shall
respectively prevent eviction, foreclosure, or termination of utility
service;
b. A signed and dated
statement from an outside source indicting that it shall provide payment of the
remainder of the back rent, mortgage principal and interest, or utility bill;
or
c. A signed and dated statement
from the landlord, mortgagee, or utility company indicating that a payment plan
has been arranged for the balance of the arrearage;
(6) An eviction notice, court order, notice
to quit, or a signed and dated written demand for rent for an actual or pending
eviction, indicating the name of the landlord and the amount of the back
rent;
(7) A notice of foreclosure,
court order, or a signed and dated written demand for mortgage principal and
interest initiating foreclosure proceedings, indicating the name of the
mortgagee and the amount of the back mortgage principal and interest;
(8) A currently dated bank book or bank
statement, or a signed and dated statement from a representative of the
financial institution for personal property resources;
(9) Fuel assistance termination letter, or a
signed and dated statement from a representative of the organization
administering federal fuel assistance payments specifying the reason that fuel
assistance is not available to meet the emergency need;
(10) One of the following, if verifying
incapacity:
a. A check, letter or other
document from the social security administration indicating receipt of social
security disability benefits or supplemental security income benefits;
or
b. A physician's statement
indicating that the individual is disabled and unable to work for a period of
at least 30 days from the date of application for emergency assistance;
or
(11) A bill, or
signed and dated statement by a representative of the provider indicating the
amount of the employment related barrier expense.
(12) One of the following, if there are
unsafe or unhealthy living conditions:
a.
Documentation of the unsafe or unhealthy living conditions from a third party,
including but not limited to a school nurse, school counselor, social worker,
case manager, therapist, housing and support services, town welfare, primary
medical provider, or pastoral support; or
b. The individual's written self-attestation
of the unsafe or unhealthy living conditions.
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