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NYS Office of Temporary and Disability Assistance- TA and SNAP Employment Policy Manual

Section 385.2 – Page 32

Rev. 4/2025 A.4 Districts must use the LDSS-4005 Notification of Temporary Assistance Work Requirements Determination (Exempt) (or an approved local equivalent) to notify an individual that they have been determined to be exempt whenever an individual alleges to be unable to participate, or the individual otherwise participates in the employability disability review process described in 18 NYCRR 385.2. This notice is included in Appendix C of the Employment Manual. Q.5 What is the difference between the LDSS-4005 (Notification of Temporary Assistance Work Requirements Determination (Exempt)) and the LDSS-4005(a) (Notification of Temporary Assistance Work Requirements Determination (Nonexempt)) and when must they be issued? A.5 The LDSS-4005 (Notification of Temporary Assistance Work Requirements Determination (Exempt)) is issued to notify an individual they have been determined to be exempt from work requirements. The LDSS-4005(a) (Notification of Temporary Assistance Work Requirements Determination (Nonexempt)) is issued to notify an individual they have been determined to be non-exempt from employment requirements. Districts must issue the LDSS-4005 or 4005(a) under the following circumstances: • Whenever an individual alleges to be unable to participate (for medical or nonmedical reasons); • The individual otherwise participates in the employability disability review process; and • Whenever an individual’s status changes from exempt to non-exempt, including drug/alcohol. Following are several examples of circumstances describing when the 4005 or 4005(a) should be issued: Example of change from exempt to non-exempt: An individual who was previously determined to be exempt because they were the caretaker of an incapacitated household member would be issued the 4005(a) if circumstances change and the individual is subsequently determined to be non-exempt. Example of when an individual requests an exemption: An individual submitted medical documentation to support an extension of their existing exemption would either be issued the 4005 or 4005(a) based on the district’s determination. Example of when an individual participates in the disability review process: An individual for whom the district collects medical evidence consistent with the disability review process described in 18 NYCRR 385.2 because they allege to be unable to participate due to a health-related issue, or the district suspects the individual has a health-related issue and the individual has demonstrated an inability to successfully participate in work activities, would be issued either the 4005 or 4005(a) based on the district’s determination.