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

Appendix A- Page 16 Rev. 3/2022 CONCILIATION SUMMARY

CASE#: CLIENT NAME: DATE OF CONCILIATION NOTICE: DATE OF OCCURRENCE: ALLEGED ACT OF NONCOMPLIANCE: TYPE OF CONCILIATION: ☐ TA/SNAP ☐ TA only

☐ SNAP only CONCILIATION RESPONSE DUE DATE:

Did the client respond to conciliation? ☐ YES Date of response: ☐ NO CONCILIATION CONDUCTED: ☐ YES ☐ NO SUMMARY OF THE CONCILIATION:

DETERMINATION: ☐ Resolved (explain below), NO SANCTION ☐ Not willful and without good cause, NO SANCTION ☐ Willful and without good cause, SANCTION IMPOSED ☐ No response to conciliation, no evidence of good cause, SANCTION IMPOSED

☐ The client is subject to SNAP conciliation and was informed of the option to avoid a SNAP employment sanction through demonstrated compliance (for TA/SNAP and SNAP only conciliations).

Activity assigned: _____________________________________________________________

If the client’s failure to comply was both willful and without good cause, and the client is subject to a SNAP employment sanction did they demonstrate compliance to avoid the SNAP sanction?

 The client demonstrated compliance, NO SNAP SANCTION  The client did not to demonstrate compliance, SNAP SANCTION IMPOSED

COMMENTS (details of determination including client responses, how district determined the client was both willful and without good cause, if the client was determined to not be willful or had good cause please provide details as to steps the client can take to avoid future noncompliance):