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

Appendix C – Page 16 Rev. 3/2022

Instructions for Completing the LDSS-4230

The Conciliation Notification (LDSS-4230) should be used for TA only noncompliance and for TA/SNAP noncompliance in those instances where a manual conciliation notice is needed. The form contains a section to include information on the ability to avoid a SNAP sanction through demonstrated compliance with work requirements for TA/SNAP cases. When a TA/SNAP recipient is non-exempt from SNAP work requirements workers should select one of the available options under the “Demonstrate compliance with the assigned SNAP work requirement(s)” section to instruct the client to either contact the agency for information, to directly report to a provider or to comply with job search to demonstrate compliance.

Note: The SNAP section of the manual LDSS-4230 should be left blank if the noncompliance applies only to PA employment requirements (such as if the individual is exempt from SNAP E&T requirements).

The upper section of the document is used to provide identifying information which is self- explanatory. Each box must be filled in. The worker must specify the instance(s) of refusal or failure to comply and detail the work activity or work requirement the individual failed to comply with. Workers should refrain from using acronyms or abbreviated descriptions for work activity assignments. The section, How This Affects your Public Assistance Benefits must be filled out and indicate the agency contact phone number and worker name, and the date that contact must occur by. The date should allow individuals at least ten days from the date of the conciliation notice (regardless of case type) the opportunity to respond to the conciliation notice and/or re- engagement in SNAP work activities. This includes all individuals receiving FA, SNA-MOE, SN non-MOE, NTA/SNAP and SNAP mixed cases. The section How this Affects your SNAP Benefits must be filled out and direct the individual to either: 1. contact staff at the specified phone number by the date indicated or; 2. demonstrate compliance with the assigned SNAP work requirements by: 1. contacting the staff at the agency by the specified date and time or; 2. appearing at the referred to work activity listed on the notice or 3. look for work by engaging in a job search. Note: the date on the notice should allow individuals at least ten days from the date of the conciliation notice (regardless of case type) for the opportunity to respond to the conciliation notice and/or re-engagement in SNAP work activities.

Individuals may be assigned to the same work activity to demonstrate compliance to avoid a SNAP sanction, unless the district determines that the work activity is no longer available or is no longer consistent with the individual’s employment assessment and plan. Additionally, no