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

Appendix A- Page 1 Rev. 3/2022 Appendix A - Model Documents and Worker Aids Table of Contents Appendix A - Model Documents and Worker Aids ...................................................................... 1 Agreement with Worksite Sponsor Agency ............................................................................. 2 Waiver of New York State Medical Review Procedure ............................................................ 7 Sample Cover Letter to Accompany the Request for Medical Information .............................. 8 LDSS-4826B Interview/Verification Guide for the Supplemental Nutrition Assitance Program (SNA) Application and Recertification ..................................................................................... 9 LDSS-4958 TA Sanction and Denial Policy/Participation Rate Impact Desk Guide ...............14 LDSS-5122 Supplemental Nutrition Assistance Program Employent and Training Sanction Desk Guide ...........................................................................................................................14 LDSS-4923 TANF and SNA MOE Work Activities Countability Desk Guide (Households with Dependent Children) .............................................................................................................14 LDSS-4924 SNAP non-MOE Work Activities Countability Desk Guide (Households without Dependent Children) .............................................................................................................14 LDSS-4925 Employability Code Desk Guide TANF and SNA MOE (Households with Dependent Children) .............................................................................................................15 LDSS-4926 Employability Code Desk Guide SNA non-MOE (Household with Dependent Children) ................................................................................................................................15 LDSS-5062 SNAP Employability/ABAWD Code Desk Guide .................................................15 Sample Conciliation Summary Template ...............................................................................15