Page 491

Report of Non-Compliance with TANF Requirements - form issued by TANF operations unit to report non-compliance with TANF work requirements. TANF Work Activity Referral - form used to refer mandatory and voluntary applicants/recipients to Job Club, Teen Parent program, and Negotiated Suitability Training (for those interested in self-initiated training). The referral form can also be used to refer applicants/recipients who need child care assistance to the Office of Early Childhood Development. Original forwarded, copy in record, copy to customer. Token Receipt Form - form completed by SSR authorizing bus tokens. Original to customer, copy in record, copy to TANF operations unit. Voter Registration Agency Certification - form completed by recipient when a household's address changes or a voting-age adult is added to the unit indicating whether the recipient would like to obtain a voter registration form. Original in record. Numbered Forms

FSET-1 Food Stamp Registration for Employment and Training Services - form completed at application and annually thereafter by FS recipients mandated to work register. The form serves as the work registration and the referral form to the FSET program. Original to FSET, copy in record. FSET-3 Report of Non-Compliance - form sent to SSR by FSET to report recipient's non-compliance with FSET requirements. 1-2140 Spend-down Tracking Form - form sent to the Medical Assistance Administration so that medical bills are paid for spend-down customers. Original forwarded to MAA, copy in record. 26 Expedite Form - form required at application and recertification to determine if applicant/recipient is eligible for expedited food stamp service. While required at recertification, individuals recertifying FS eligibility that have experienced no break or lapse in benefits are ineligible for expedited processing. Original in record, copy to applicant/recipient. 30A Medical Assistance Data Entry Form - form that indicates Medicaid eligibility period for spend-down, YSA, CFSA, and other customers. Original in record. 30-AW Medical Assistance Data Entry Form - form that indicates Medicaid eligibility period for Medicaid Waiver and Demonstration customers. Original in record. 107 Request for BMS Investigation - form used to request an investigation from the Office of Quality Assurance & Analysis (formerly known as the Bureau of Management Systems). Original to OQAA, copy in record. 107 Verification of Residence - form that can be used to verify residence. 107 Verification of Employment - form that can be used to verify employment and earnings. 107 Verification of Child Care - form that can be used to verify child care expenses.