ADDENDUM 109 A

CANO FORMAT

Subject

CANO Guide

RECORD TITLE

APP DATE & BSD:

• This section is for documenting application and benefit start dates, and offering other programs that the applicant did not check on the application.

• Document if a copy of the application and other documents are submitted to an NFAP agency.

• Omit documenting the application and benefit start dates if the dates are the same. If the dates are different, explain based on specific program rules and requirements why the application date and benefit start date are different.

• Exception: CAMA and Medicaid application, recertification and reviews – the difference with the app date and BSD do not need to be documented for these situations.

• Example: BSD – 11/25/11 (reason why it is different); informed PI about other DPA programs available for the household, but PI declined to apply.

INTERVIEW DATE:

• If interview is conducted by phone, document if the client verified their identity using their date of birth and last four digits of the SSN.

• Document if interpreter service was offered and used.

• If interpreter service was offered but the client refused, document this action.

• If interpreter service was used, document the type of interpretation provided such as telephonic with DPA contracted service, or in-person.

• If the service was in-person, document the name of the interpreter and relation to the applicant (e.g., family member, third party, state employee, etc.).

R&R:

• Document if rights and responsibilities were discussed and understood. If no interview is required, omit documenting R&R.

• If the interview was conducted by a fee agent, document that fee agent has discussed rights and responsibilities to the client and given the client a copy of the Rights and Responsibilities form (GEN 51) as indicated in the fee agent checklist.

HHC/ROPD:

• Document relationship as it pertains to specific program(s) – name and relationship of persons in the household.

• Document non-MFU persons in the household. If there are people in the home who are not on EIS or the application, list who and why they are not included. A reviewer should be able to look at the CANO and EIS and tell exactly who lives in the home and their relationship to the members of the participating household.

• If there is alien in the household, check ASVS. Document Alien entry date. Document student status if it affects eligibility.

• Document individuals in household who are considered responsible for the care of the applicant (GA/CAMA).

• Document if there is someone in the household who is disqualified, the reason for the disqualification and the dates of disqualification. Reference the appropriate CANO relevant to the disqualification.

• Address drug or fleeing felon issues, felony conviction dates and how it was verified.

• If there is an absent parent, shared custody and the child moves between the homes on a regular basis, document if applicant/PI has custody of the child more than 50% of the time. Whenever possible, verification from the other parent of where the child is expected to be living should also be documented (TA MS 711-6B).

• Document what permanent documents were used to prove identity and relationship/kinship to PI or specified relatives, how the documents were obtained and verified.

• Create a separate CANO when POA and guardians are assigned.

ADDRESS AND TELEPHONE

• Enter the interview date and next interview date (month and year) on the ADDR screen.

• If applicant has a second language, enter this information on ADDR.

• Document address (physical and mailing address) or telephone (home, cell, work or message number) only if the information on the ADDR screen is different from what is written on the application or recertification, or if an explanation is needed.

• Document that applicant stated they are currently residing and intends to stay in Alaska.

PRIOR SUPPORT:

• Write a summary of the household’s means of family support before applying for assistance and what has changed (job, income, resources, etc.)? Provide details about income or resources in the appropriate section as required.

• Did the household receive TANF in Alaska or from other states (include Tribal TANF)? Was the household living in a exempt village.

• If the HH is new to the state: What brought them to AK?  Were they receiving benefits in the prior state?  If yes, contact the state and verify.  Did a job end?  If yes, when did it end, why did it end? Is the member eligible for UIB from that state?  How did they pay for their travel to Alaska?

WORK REQUIREMENTS

/DISABILITY/

PENALTIES

·         Document penalty information. Document intent to cure penalty date and referred to partner agency for resolution.  Also, document if anything else such a penalty, job-quit, barrier, good cause, or exemption needs further explanation or clarification.

·        Document TA-10 and disability date if necessary.

·        Med11, AD-2, date of SSI application, DDS referrals or decisions, SSI or SS-DS

•   Determination of incapacity status

•   Document that IA reimbursement process was explained to client and the date the IAR was received and signed.

•   Document the track the client has been assigned based on answers provided on the ITT (FF or WF).

RESOURCES

• Document information that is not clearly identified on EIS. If information reported on the application differs from what is entered on EIS, provide further explanation or clarification in CANO

• Was there any transfer of assets

• Review liquid and non-liquid resources

• Are there any individuals in the HH who are considered responsible for the care of the applicant (GA/CAMA)

• Examples of information to document:

1. If someone in the household owns Native dividends, document the owner’s name, number of shares, and the name of the corporation issuing the dividends.

2. If someone in the household has a bank account, it is not necessary to document changes in bank account balance because this information is reflected on the FIAC screen. However, if the account closed or a new account is opened, this information must be documented.

3. If someone in the household owns a vehicle, the value of the vehicle does not need to be documented because this information is reflected on the VEHI screen. However, if the vehicle was sold and the household obtained a new vehicle, this information must be documented.

STUDENT STATUS

• Household members receiving school loans, scholarships, and grants

• Document if there is a post-secondary education – name, date of graduation, and if they are eligible student or not and an explanation.

• Document if the household includes an 18 or 19 year old high school student – name and date of graduation.

• Document if there are children under 18 who are working and not attending school (income is countable).

INCOME

·         This is a critical portion of the CANO and documentation must be complete and detailed. Document the type of income, how it was verified, and the calculation (actuals, averages, and conversion factors) used to determine eligibility and benefit amount.

·         Types of income to document:

Ø Unearned income - source and amount

Ø Earned income - employer name and phone number; calculation of prospective income; regular/temporary; part-time/full time; seasonal

Ø Self employment income - seasonal or annual; income and expenses as allowed (50% or actual)

·         Document any development of Income such as pursuit of other income such as UIB, SSI, retirement, etc.

·         Document any relevant information found in DOL, NSTAR, and SOLQ

·         Make sure to also document the following:

Ø  Fluctuating income

Ø  Changes in pay rates

Ø  Changes in hours

Ø  Excluded income

·         Include the following items in the documentation:

Ø Client’s Name     

Ø Pay period ends   

Ø Pay date  

Ø Gross Pay/Tips  

Ø Hours  

Ø Gross Y-T-D

Ø How income was verified

•   Document collateral contacts made and attempted.

DEMH

·         Document information that is not clearly identified on EIS. If information reported on the application differs from what is entered on EIS, provide further explanation or clarification in CANO

·         Household expenses (rent, mortgage, child care, child support paid, medical expenses for SPECAT members, utilities, taxes, insurance)

·         Are expenses shared?  Be sure to reduce allowable shelter deductions by GA or in-kind income amounts.

·         Emergent need for GA

·   Heating Assistance (allow as SUD deduction)

·   Homeless shelter deduction (code DEMH screen with OE AT)

·         Document collateral contacts made and attempted, and reason why.

MED:

·         Document only if there is TPL/TPR, private insurance. Refer to MS 109-9H for additional guidance on documenting TPL/TPR

·         Document request for retroactive Medicaid coverage.

·          Check previous medical insurance coverage. Provide further explanation or clarification if there is an issue.

·         If pregnant, indicate estimated due date

·         SLMB, QMB

·         Medicare Buy-In

·         CAMA criteria met/MED 11

CC:  

• Document collaterals made and attempted in the specific subject area. For example, employers that were contacted to verify income must be documented in the income section. Collateral contacts made to landlords must be documented in the DEMH section.

• For this section, only document collaterals that are not included elsewhere. For example, if you called a neighbor or relative to verify general household information and it doesn’t fit in any of the specific sections, document it here.

·         Document what type of action was taken (i.e., authorize, deny, pend).

·         If the case is pended, you have the option of documenting the information needed.

·         Document cert-thru dates. Explain if the cert-thru date is out of the ordinary.

·         Document the benefit month(s) authorized.

·         Documenting issuance code is optional.

·         It is highly recommended and preferred to document notices that were sent, but it is not required.

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2012-02 (11/12)