310-1             THE APPLICATION FORM

310-1 A.    WHAT IS AN ACCEPTABLE APPLICATION FORM?

The Application for Services (GEN 50C) and the Senior Benefits Application (GEN 152) can be used to apply for the Senior Benefits Program. Eligibility cannot be determined until the household completes one of these application forms. Faxed applications are accepted.

The Senior Benefits Application (GEN 152) is the recertification application form that is used to determine continued eligibility for Senior Benefits. The Eligibility Review form (GEN 72) may also be accepted starting with the April 2020 form revision.

• If received in the month following case closure for any reason, the GEN 72 form can be used as an initial application form.
   
• If received after the month following the end of the review/recertification period, the GEN 152 or GEN 50C application form is required. The GEN 72 form will be accepted to protect the benefit start date, however, it cannot be used as the initial application form.

310-1 B.    WHEN IS AN APPLICATION REQUIRED?

1. Upon the individual’s first application for the Senior Benefits Program, even if the individual is already a recipient of another DPA(Division of Public Assistance) program.
    
2. Upon application from a denied, withdrawn, or closed status, unless the denial or closure was the result of an administrative error.
    
3. Any time the Senior Benefits worker believes the individual’s circumstances have changed sufficiently to justify conducting a special redetermination of eligibility, including when an office conducts a special review project for all or part of its caseload.

310-1 C.    WHEN IS AN APPLICATION NOT REQUIRED?

1. To reopen a closed case as a result of an individual’s timely request for a fair hearing, or to open or reopen a case as the result of a fair hearing decision.
    
2. To reopen a case that has been closed incorrectly.
    
3. To redetermine eligibility after the application is denied for failing to provide verification and the household provides the verification within 30 days from the application filing date.
    
4. When there is an address change.
    
5. To resume benefits after benefits have been suspended.

310-1 D.    WHAT IS AN IDENTIFIABLE APPLICATION?

An identifiable application is a Senior Benefits Program application form (GEN 152) or Application for Services form (GEN50C) containing the applicant’s name, address, and signature (or witnessed mark) of the individual seeking assistance, or of the individual’s authorized representative.  If an application is not identifiable, it should not be registered in EIS(Eligibility Information System).  The application should be mailed back to the client with a short note explaining what is required.  Each DPA(Division of Public Assistance) office must accept and date an identifiable application when it is presented, register the application, and then forward the application to the Senior Benefits Office for processing.

An individual who contacts a DPA(Division of Public Assistance) office and who shows interest in the program or a desire to apply shall be advised of his or her right to submit an identifiable application on the date of the contact in order to establish the benefit start date.  The individual may file an identifiable application on an acceptable application form, as described at manual section 310-1A.

See MS 310 for application signature requirements.

310-1 E.    WHO CAN SIGN THE APPLICATION FORM?

• An adult household member, age 18 years or older
   
• An authorized representative
   
• An individual who has legal authority to act on the applicant’s behalf (i.e., Office of Public Advocacy, legal guardian)
   
• An individual with appropriate power of attorney
   
• A responsible person, if the individual filing the application is incapable of applying or appointing an authorized representative

Any person has the right to apply for the Senior Benefits Program and can sign the application.  The proper person to sign the Senior Benefits application is the applying senior.   If both members of a married couple wish to apply, they may do so on a single application form if both spouses sign the form.  If the applying adult is incompetent or incapacitated, or wishes to appoint an authorized representative, a responsible person acting on the individual’s behalf may also apply for him or her.

See MS 310 for application signature requirements.

310-1 F.    WHO CAN BE AN AUTHORIZED REPRESENTATIVE?

A responsible adult, 18 years or older, may be designated by the applicant in writing as an authorized representative.  If the applicant is illiterate, his/her mark must be witnessed by two individuals who must each sign their names and date the document.  No special form is required.

Authorized representatives may sign the application and act on behalf of the household.  A household member should prepare or review the application, if possible, even though the authorized representative will be filing the application.

310-1    G. COMPLETING THE APPLICATION

In addition to making an identifiable application and having it signed by an eligible individual, the applicant must answer all of the questions on the application form.  If the application form is not completed, the Senior Benefits worker will allow the household the opportunity to complete the form.  In this case, written notification will be sent to the household listing the items that need to be completed.