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STATE OF HAWAII BENEFIT, EMPLOYMENT DEPARTMENT OF HUMAN SERVICES AND SUPPORT SERVICES DIVISION DHS 1259 (REV 06/2022) Page 1 of 1 TEMPORARY ASSISTANCE FOR NEEDY FAMILIES (TANF) WORK PROGRAM REFERRAL AND REQUIREMENTS Name of Applicant / Recipient Case Number Processing Center Date This form explains the referral and work program requirements of the TANF Program. The work program will help you and your family to move from receiving financial benefits to employment. Please read this form and keep for your records. If there are any questions regarding this form, please call the Public Assistance Information Line at 1-855-643-1643. PURPOSE: The TANF Program has work participation requirements, as a condition of eligibility for recipients who can work, as well as vocational rehabilitation services for recipients who may be temporarily unable to work. Recipients who can work will be referred to the First-To-Work (FTW) Program and will need to participate and meet participation requirements. Recipients who are unable to work full-time (at least 30 hours per week) will be referred to the FTW Vocational Rehabilitation (FTW-VR) office to receive services to help remove the temporary barriers. The FTW Program helps recipients to prepare for and find employment; assists with rehabilitation and treatment services; and pay for child care, transportation costs and other expenses while participating in the FTW Program. PART I – NON-WORK ELIGIBLE INDIVIDUALS: If any of the following reasons prevent you from working, you will not need to participate with the FTW Program. When you no longer meet any of the following conditions, you will need to participate with the FTW Program. 1) You are a single parent caring for your child who is under six (6) months old and have not used the lifetime exemption limit of twelve (12) months. 2) You are a parent caring for an ill or disabled family member living in your home, supported by medical documentation. 3) You are not applying for help for yourself but are applying for help for child(ren) that is not your own (non-needy caretaker). PART II – OTHER WORK ELIGIBLE INDIVIDUALS: If you feel that you are unable to work because you are disabled, receiving treatment for substance abuse disorder, or currently in a domestic violence crisis, you will be referred to the FTW-VR office as a condition of eligibility for financial benefits. You will be asked to submit verification if your family meets one of the following and must be certified by department authorized providers. 1) You have been disabled for thirty (30) days or more and cannot work. 2) You recently or currently in a domestic violence situation and cannot work. 3) You are sixty-five (65) years of age or over. PART III – PENALTIES FOR NON-COMPLIANCE: If you do not meet any of the criteria listed in Part I above, you must participate with the FTW Program. Participation with the FTW Program includes keeping appointments and completing work activities in your Employment Plan. If you do not complete your activities or refuse to participate without good cause, your family’s financial benefits will stop. The following are the sanction (disqualification) periods: FIRST SANCTION: Family will not be eligible until you reapply for benefits. SECOND SANCTION: Family will not be eligible for a minimum of two (2) months; and THIRD AND SUBSEQUENT SANCTIONS: Family will not be eligible for a minimum of three (3) months. Auth: Hawaii Administrative Rules Chapters 17-656.1 and 17-794.1 Attachment B-1