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COMMONWEALTH OF VIRGINIA

To_________________________________, ESW DEPARTMENT OF SOCIAL SERVICES

From_______________________________, BPS EMPLOYMENT SERVICES PROGRAMS

Date_______/_______/_______ COMMUNICATION FORM- From BPS to ESW Reply Needed By _______/_______/_______

 Copy Sent to Child Care Worker ====================================================================================== Name of Participant______________________ Participant’s Client ID # ____________________ Case Name _____________________________  SNAPET  TANF  TANF-UP Case Number ___________________________

======================================================================================  Reapplication for TANF - Previous Failure to Sign Agreement of Personal Responsibility. APR signed on _______/_______/_______ (APR attached). Effective Date of TANF approval: _______/_______/______.  Result of reevaluation of non-exempt/mandatory status: _________________________________________  Volunteer no longer wishes to participate.  Non-exempt/mandatory individual now exempt. Reason: ________________________________________  Individual may be unable to participate in ESP/SNAPET program because __________________________ ______________________________________________________________________________________  Individual is not able to  Read English  Write English ======================================================================================  Individual will enter/entered employment at ___________________________on_______/_______/______. Scheduled # of Hours/week______________. Rate of pay $____________ per _____________. Frequency of pay: _____________________. Date of First Pay: _______/_______/_______. ======================================================================================  Individual/household no longer eligible for SNAP. Case closed due to: (check one)  Employment/benefit reduction/savings information provided below  Other: ______________________________________________________________________________. Effective Date: _______/_______/_______.  Individual removed from the SNAP household because ________________________________________ ____________________________________________________________________________________ Effective Date: _______/_______/_______.  Effective with payment on _______/_______/_______, benefits will be reduced from $________ to $_______. ======================================================================================  Individual appealed TANF sanction. Case remains open until appeal resolved.  TANF Sanction ended effective _______/_______/_______.  TANF case reopened. ======================================================================================  24-Month Eligibility Termination date: _______/_______/_______.  Appeal prior to 24-Month Closure or  Appeal of Hardship Denial prior to 24-Month Closure. Appeal scheduled for: _______/_______/_______.  Client has requested that case remain open until appeal resolved. ======================================================================================  VIEW Transitional Payment established effective _______/_______/_______.  VIEW Transitional Payment ended effective _______/_______/_______. Reason: _______________________________________________________________________________. ======================================================================================  Amount of SNAP allotment for the month of ___________________________ was $_____________.  New certification period from _______/_______/_______to _______/_______/_______. ======================================================================================  Individual is a refugee. Contact ______________________________ (refugee resettlement agency) at _____________________________ (telephone) before conducting VIEW/SNAP E&T initial assessment. ======================================================================================  Other ________________________________________________________________________________ ________________________________________________________________________________________ 032-02-0072-13-eng (09/2024)