Page 6

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

Appendix A- Page 6 Rev. 3/2022 Sample Warning Letter for Intentional Misrepresentation of a Disability This is to notify you that your household’s public assistance grant may be reduced because we believe ____________ may have intentionally misrepresented that they suffer from an impairment that would limit participation in work activities or make them exempt from assignment to work activities. If we determine, based on medical or other evidence, that ____________ intentionally misrepresented that they suffer from an impairment, your household’s public assistance benefits would be reduced pro-rata for _____ days and until ___________________ complies with employment requirements. If so, you will receive another notice that will advise your household of the sanction and the reduction in public assistance benefits. After you receive that notice, you may request a fair hearing if you do not agree with the decision. If you wish to discuss this matter with us before we make a decision, or if you have any additional information to provide, you may call ___________ at ___________ no later than __________.

Note to district: As outlined in Part B of Section 385.2 of this manual districts should document in writing in the case record when an individual with a suspected disability refuses to participate with efforts to verify the disability and chooses to participate in work activities without accommodation. The sample waiver below is available for district use that describes the requirements and benefits to the individual and has a place for the individual to sign acknowledging they have been informed and chooses to participate without accommodation. These individuals would be non-exempt and assigned to work activities without applying the disability review procedure.