705-2          THE APPLICATION FORM

705-2 A.      WHAT IS AN ACCEPTABLE APPLICATION FORM?

The Application for Services form (GEN 50C) is the initial application form that is used to apply for any public assistance program, except the Heating Assistance Program (HAP). To apply for Heating Assistance, a Heating Assistance Program application (HAP 1) must be completed.

The Eligibility Review form (GEN 72) is the recertification application form that is used to determine continued eligibility for APAAdult Public Assistance, SNAPSupplemental Nutrition Assistance Program, Medicaid, and ATAPAlaska Temporary Assistance Program. It may also be accepted for Senior Benefits starting with the April 2020 form revision.

• If received in the month following case closure for any reason, the GEN 72Eligibility Review Form form can be used as an initial application form.
• If received after the month following the end of the review period, a GEN 50CApplication for Services application form is required. The GEN 72Eligibility Review Form form will be accepted to protect the benefit start date, however, it cannot be used as the initial application form.

The Native Family Assistance Program (NFAP) application form is an acceptable application form for APAAdult Public Assistance, SNAPSupplemental Nutrition Assistance Program, Medicaid, and ATAPAlaska Temporary Assistance Program.

705-2 B.      WHEN IS AN APPLICATION REQUIRED?

1. Upon the individual's first application for a program, even if the individual is already a recipient of another DPADivision of Public Assistance 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 Upon application from a denied, withdrawn, or closed status, unless the denial or closure was the result of an administrative error.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 caseworker 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.

4. When there is a change in the caretaker relative with whom the Temporary Assistance child or children are living.

5. When the recipient of a NFAPNative Family Assistance Program is no longer eligible for that program because they no longer live in the NFAPNative Family Assistance Program's service area or the family is no longer part of the NFAPNative Family Assistance Program's service population.

705-2 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 had been closed incorrectly.

3. To resume benefits after benefits have been suspended.

4. To redetermine eligibility after the application is denied for failing to provide verification and the family provides the verification within 30 days from the application filing date.

5. To redetermine eligibility after the application is denied for failing to participate in an interview and the family contacts the office to reschedule the interview within 30 days from the application filing date.

6. When there is a change in "payee," "In care of" addressee, or mailing address.

7. When individuals are added to an open case.

8. When the Temporary Assistance case changes in status from Adult Included (AI) to a Child Only.

9. When the Temporary Assistance benefit is restored after a Temporary Assistance penalty is ended.

10. When a family is ineligible for the first month but eligible for the second month. See ATAPAlaska Temporary Assistance Program MS 705-5 A.

705-2 D.      WHAT IS AN IDENTIFIABLE APPLICATION?

An identifiable application is an acceptable application form containing the applicant's name, address, and signature (or witnessed mark) of the individual seeking assistance or of the individual's authorized representative. Each DPADivision of Public Assistance office must accept and date the identifiable application when it is presented. See ATAPAlaska Temporary Assistance Program MS 705 for application signature requirements.

An individual who contacts a DPADivision 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 and 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 ATAPAlaska Temporary Assistance Program MS 705-2 A.

705-2 E.      WHO CAN SIGN THE APPLICATION FORM?

• An adult family member
• A minor parent
• 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 and of appointing an authorized representative in writing.

The signer must certify, under penalty of perjury, the truth of the information contained in the application.

The appropriate individuals to sign an ATAPAlaska Temporary Assistance Program application are TATemporary Assistance caretaker relatives of dependent children, the authorized representative of a TATemporary Assistance caretaker relative, or, if the caretaker relative is incompetent or incapacitated, an individual acting responsibly for him or her. If a child is living with more than one caretaker relative, any of the relatives may be an eligible signer of the ATAPAlaska Temporary Assistance Program application. To be included in the assistance unit, the caretaker must sign the application.

When both parents are included in the case, both must sign the application. See ATAPAlaska Temporary Assistance Program MS 705 for application signature requirements.

705-2 F.      WHO CAN BE AN AUTHORIZED REPRESENTATIVE?

A responsible adult, 18 years or older, may be designated by the applicant in writing as 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 a family. A family member should prepare or review the application, if possible, even though the authorized representative will be filing the application and/or participating in the interview.

705-2 G.      COMPLETING THE APPLICATION FORM

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. The applicant must also attest to whether the family has previously received assistance from another state's Temporary Assistance for Needy Families (TANF) program or a Native Family Assistance Program (NFAP) in order to determine the number of months used towards the 60-month time limit on assistance.

If the individual requests help in completing the application form, the caseworker will offer assistance.

If the application form is not completed, the caseworker will allow the family an opportunity to complete the form. In this case, written notification will be sent to the family listing the items that need to be completed. See ATAPAlaska Temporary Assistance Program MS 705-5 C.