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

Appendix C – Page 13 Rev. 3/2022

The third chart should include the names of each household member who is subject to the ABAWD work requirements.

If a household member is subject to more than one category of SNAP work requirements their name should appear in all applicable work requirements sections. In a district that does not mandate SNAP E&T for their NTA/SNAP population, a non-exempt adult in an NTA/SNAP household should be listed in the General SNAP Work Rules section but would not be listed in the SNAP Employment and Training (E&T) Assignment section. Districts must retain copies of all LDSS-5193 notices provided to the household and must also document the case record through case notes/comments when the comprehensive oral explanation pertaining to SNAP work requirements occurs. LDSS-5193A IMPORTANT INFORMATION ABOUT SNAP WORK RULES (GENERAL AND MANDATORY E&T) When to Use an LDSS-5193A

In accordance with guidance outlined in 22-ADM-01 Oral and Written Requirements to Inform SNAP Applicants and Recipients of SNAP Work Rules districts are required to provide a notice of consolidated work requirements and oral explanation to all households where at least one member is subject to a SNAP work requirement, describing the pertinent work requirements. LDSS-5193A Important Information about SNAP Work Rules (General and Mandatory E & T) includes information regarding the general SNAP work requirements and mandatory SNAP E&T but does not explain the ABAWD work requirements. This notice should be provided to households where at least one household member is subject to the general SNAP work requirements or mandatory SNAP E & T but where no household member is subject to the ABAWD work requirements including households where all household members have been determined to be non-ABAWDs and households that reside in an area with an ABAWD waiver. The LDSS-5193 should be provided as explained at certification, recertification, and when a previously exempt household member or new household member becomes subject to work requirements. As indicated in the previous section, districts should use the LDSS-5193A during periods of a statewide ABAWD waiver as during that time ABAWDs residing in all areas of New York State are not be subject to the ABAWD requirements.

Instructions for Completion

Districts are required to complete the information in the top portion of the first page of the notice including Date, Case Number, and District Contact Number. In the applicable work requirements sections, districts should list all members of the household who are subject to each of the different types of SNAP work requirements. The two charts on the first page of the notice must be completed in accordance with the household’s specific circumstances: The first chart should include the names of each household member subject to the general SNAP work requirements.