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63-1251 FORM MODIFICATION POLICY — APPENDICES (Continued) 63-1251 2 Appendix 2 — Definitions

Data Element - Each independent unit of information is considered a data element for purposes of identifying form-specific modification criteria. In some cases a data element is a

single word, such as “date”, and in other cases a data element is a complete message, such as, ‘Wf you have any questions, please contact me”.

Form Designation - Required Form-No Substitutes, Required Form-Substitutes Permitted, and Recommended Form are the three form designations used under this policy.

Form Modification - Except as provided under “Exemptions from Modification Policy”, any designated form used by a county which has been altered in any way or which has not been obtained from state-printed stocks is considered a form-modification. This includes, but is not limited to, computer-generated forms and county-printed forms where either a state- provided camera-ready copy was not used or the camera-ready copy was altered.

Form-Specific Modification Criteria - For each designated form, variations in placement, language and data elements which will not be considered are identified under form-specific

modification criteria. The development of these criteria is based upon the reasons for assigning a form its designation.

Internal County Form - A form required for internal county use which does not involve the determination or notification of eligibility or benefit level, or the notification of client rights and responsibilities is considered an internal county form and is not subject to review under

this policy. Some examples of internal county forms are route slips, some verification forms, and case narratives.

Justification - The averriding county-specific situation presented as the reason for modifying

a state-required form is a justification. Acceptable justifications for each category of form designation are provided in this policy.

Language - The specific wording used on a form: is considered language for purposes of identifying form-specific modification criteria.

Placement - The order of data elements as they appear on a form is considered placement for purposes of identifying form-specific modification criteria.

Recommended Form - Forms assigned this designation are optional county forms. Should a county elect to modify a recommended form, the modification must be reviewed by the

FSPMB to ensure that the modifications meet the variation standards for a Recommended Form.

Required Form — No Substitutes - Forms assigned this designation must be implemented by all counties uniess a modification request, based on acceptable justification for a form with this designation, is approved by the FSPMB,

(MANUAL LETTER NO. 81-51)