UPM 1555.20 - Change Report Form

CONNECTICUT DEPARTMENT OF INCOME MAINTENANCEPRIVATE UNIFORM POLICY MANUAL ______________________________________________________________________________ Date: 7-1-87 Transmittal: UP-87-2 1555.20 ______________________________________________________________________________ Section: Type: Eligibility Process POLICY ______________________________________________________________________________ Chapter: Program: AFDC Interim Activity AABD _______________________________________________________________ MA Subject: FS Change Report Form ______________________________________________________________________________

1555.20 A. EMS Dependency

1. Prior to implementation of the EMS system, change report forms are utilized only in the FS program.

2. Subsequent to EMS implementation, the change report form is used uniformly for all assistance programs.

B. Providing Forms to Recipients

1. Assistance units are provided with change report forms in order to facilitate the reporting of interim changes.

2. Change report forms are issued at the following times:

a. at the time of application when assistance is granted; and

b. at the time of redetermination if eligibility is continued; and

c. subsequent to the receipt of a change report form from an assistance unit.

3. Self-addressed envelopes with prepaid postage are issued along with change report forms.

C. Contents of the Form

1. At a minimum, the change report form includes the following:

a. space to indicate the nature of the change and whether the changed circumstances are expected to continue beyond the report month; and

b. assistance unit reporting requirements; and

c. a reminder that FS assistance units are entitled to claim actual utility expenses; and

d. penalties associated with the failure to report changes.

2. The change report form may also include any other relevant information as deemed necessary by the Department.