Model Local Welfare Guidelines
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Table of Contents
Introduction
Definitions
- Severability
III. Confidentiality of Information
- Roles of Local Roles of Local Governing Body and Welfare Official
- Maintenance of Records
- Application Process
VII. Verification of Information
VIII. Disbursements
- Determination of Eligibility and Amount
- Non-Residents
- Municipal Work Programs
XII. Burials and Cremations
XIII. Right to Notice of Adverse Action
XIV. Fair Hearings
- Liens
XVI. Recovery of Assistance
XVII. Application of Rents Paid by the Municipality
Appendix A: Allowable Levels of Assistance Payments
Appendix B: Explanation for Disqualification for Noncompliance with Guidelines
Appendix C: Adopted Ethics Resolution on Responsibility for Persons Who Change
Their Residence While, or As a Result of, Applying for Local Welfare
Appendix D: New Hampshire Welfare Benefit Programs
Appendix E: Forms
Form A: Application for Assistance
Form B: Authorization for the Release of Information – DHHS
Form C: Notice of Rights of Anyone Receiving Assistance
Form D: Applicant’s Authorization to Furnish Information
Form E: Applicant’s Authorization to Furnish Information
(Specific Agency/Individual).
Form F: Required Verifications
Form G: Intake Form
Form H: Municipal Welfare Department Medical Release and Report
Form I: Employment Verification Form
Form J: Rental Verification Form
Form K: Budget Worksheet
Form L: Notice of Decision
Form M: Workfare Program Reporting Form
Form N: Employment Search Record.
Form O: Fair Hearing Request
Form P: Notice of Fair Hearing
Form Q: Fair Hearing Decision
Form R: Notice of Property Lien
Form S: Notice of Property Lien Discharge
Form T: Rent Voucher – Landlord Delinquency
Form U: Update Application Form
Form V: Basic Need Policy