HomeMy WebLinkAboutMINUTES - 07161996 - C70 6 . -70
TO: BOARD OF SUPERVISORS F&HS-02 Contra
FROM: FAMILY AND HUMAN SERVICES COMMITTEEIZ
Costa
County
DATE: c?TrA coorif �4�
July 8, 1996
SUBJECT:
REPORT ON THE STATUS OF THE SERVICE INTEGRATION PROJECTS
SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION
RECOMMENDATIONS:
1. ACCEPT the attached report on the Service Integration Projects.
2. APPROVE the changes in the budgeting of the Service Integration Projects
to move them from individual departmental budgets to a separate budget unit
which pulls together the funding from each of the involved departments.
3. EXPRESS the Board's appreciation for the progress which has been made in
preparing the waiver request for the State to present to the Federal
Government, as is outlined in the attached memorandum report from Nina
Goldman to Sara Hoffman dated July 5, 1996.
4. REQUEST the County Administrator to report to the Family and Human
Services Committee again on developments in the Service Integration
Projects on October 14, 1996.
CONTINUED ON ATTACHMENT: YES SIGNATURE:
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMIT
APPROVE OTHER /
SIGNATURES: MARK DeSAULNIER J F el�
ACTION OF BOARD ON July 16, 1996 PPROVED AS RECOMMENDED X OTHER
VOTE OF SUPERVISORS
I HEREBY CERTIFY THAT THIS IS A TRUE
UNANIMOUS(ABSENT ) AND CORRECT COPY OF AN ACTION TAKEN
AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD
ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN.
ATTESTED July 16, 1996
Contact: PH1LDATyCHWR,CLERK OF THE BOARD OF
CC: ep RS AND COUNTY MI STRAT R
See Page 2
• PU
. 7D
F&HS-02
BACKGROUND:
On May 21, 1996, the Board of Supervisors approved a report from our Committee
which included the following recommendations:
2. REQUEST the County Administrator's Office to provide the Family and Human
Services Committee with a timeline for the implementation of the Healthy Start
grant at the Cambridge Community Center so our Committee will be aware of
what to expect in this area.
3. REQUEST the County Administrator's Office to provide the Family and Human
Services Committee with additional background information on the Synergy
MIS System noted in the attached report,following the meeting later in May and
report this issue back to our Committee on July 8, 1996.
On July 8, 1996, our Committee met with Sara Hoffman, Senior Deputy County
Administrator, who reviewed the attached report with our Committee. We are
pleased to see the continuing progress which is being made by the three Task
Forces. We are also pleased with the outcome-related data which is being gathered
and presented to document the progress which is being made with the families being
served by the Service Integration Projects. We are especially pleased with the
waiver request which has been developed in conjunction with the State Department
of Social Services and is now ready for them to transmit to the Federal Government.
We want to continue to closely monitor developments in the Service Integration
Project sites and for this purpose are asking that a further report be made to our
Committee in three months.
cc: County Administrator
Sara Hoffman (CAO's Office)
Social Service Director
Health Services Director
County Probation Officer
Mental Health Director
Public Health Director
Community Substance Abuse Program Director
-2-
6 . 70
CONTRA COSTA COUNTY
OFFICE OF THE,COUNTY ADMINISTRATOR
651 Pine Street, 10th Floor
Martinez, California 94553
Telephone: 646-1390
DATE: July 2, 1996
TO: Supervisor Mark DeSaulnier
Supervisor Jeff Smith
Family and Human Services Committee
FROM: Sara Hoffman Pministrator Senior Deputy
SUBJECT: Status Report on Service Integration
In the May 13, 1996 report to the Family and Human Services Committee (FHS), we
reported the establishment of three task forces: the Management Task Force, the
Operations and Intervention Strategies Task Force and the Outcome Priorities Task
Force. Since then, each of the task forces developed work plans and time frames
which were reviewed at the June 4, 1996 Service Integration Management Team
(SIMT) meeting.
• Management Task Force is developing a SIT organizational chart defining
roles, responsibilities, authority and accountability for all involved;
addressing the issue of MOUs with the departments and other
management related topics. Two key issues are differentiating between
SIT staff and SIT services and the roles and responsibilities between the
team facilitator, eligibility worker supervisor and site supervisor.
• Operations and Intervention Strategies Task Force is working to
systemize the approach and content for the SIT operations and
intervention strategies, including redesign of the family assessment
records, case conferencing procedures and practices; identifying
necessary training modules (such as interview skills) to be provided by the
Greater Bay Area Family Resources Network; and defining a process to
identify the need for intervention strategies and to evaluate their success.
• Outcomes Task Force is examining the range of outcomes identified for
SIT; our success in tracking outcomes; processes to institutionalize the
tracking system; and disseminating the information. A critical issue is
6 . 70
evaluation; i.e., how do we measure if Service Integration has been a
success in the eyes of the clients, the program managers and workers,
the Board of Supervisors and the state?
Budget
Currently the cost for Service Integration is imbedded in the budgets of the Probation
Department, Social Service Department, Health Services Department and County
Administrator's Office. This has led to fragmented fiscal administration and
vulnerability to department specific program reductions. For example, substance
abuse services were lost to Service Integration with the cutbacks of FY 95-96.
Similarly, Probation is recommending reduction of the two SIT Probation Officers in the
FY 96-97 budget.
SIT is a pilot program designed to evaluate the efficiency and effectiveness of two
theories of change: 1) that family stability and family self sufficiency are closely
intertwined and must be worked on simultaneously in order to insure long term success
in either area and 2) common case management and close coordination among the
disciplines is more effective than categorical program approaches. Loss of program
components makes it difficult to determine if this approach is valid or not, since it
becomes a continually changing playing field.
The FY 96-97 Recommended Budget proposes that the Board of Supervisors authorize
and direct the establishment of a single budget unit for SIT. This budget unit would
combine the embedded costs for Service Integration from each of the departments with
backfill funding for the Service Integration Probation Officers.
If approved by the Board, the budget unit would be part of the final FY 96-97 budget.
Memorandums of Understanding between the departments would be necessary in
order to implement this change.
Tracking Employment Results
Employment has been a major focus for Service Integration. Please see Attachment
for information on the number of AFDC clients who obtained work or had earned
income with average work hours and salaries. When comparing these figures to those
of the district offices, it should be remembered that the Service Integration clients are
among the most high risk families in the system.
In North Richmond, the Family Preservation/Family Support program has focused on
job training. SIT clients were given a number of slots for this training; however fewer
attended than were referred. This prompted reexamination of the types of support
necessary to ensure participation.
Expanded employment support may be possible from two sources. The Irvine
Foundation will be issuing an RFP to support employment efforts and, after a visit to
North Richmond, expressed considerable interest in our Service Integration approach.
In addition, the Foundation for Understanding Enlightenment (FUNEN) has offered
Service Integration the opportunity to become part of an Internet network that lists entry
level job openings in Contra Costa County. (Also supportive of employment efforts, the
West Contra Costa Unified School District may be able to locate 14 of their personal
computers at the North Richmond site.)
Other events and activities of note in Service Integration include:
• a community garden has been started at North Richmond;
• the Housing Authority, St. Vincent de Paul and Rubicon have teamed up
with SIT on several funding proposals;
• two of the North Richmond team members have been accepted to
graduate school and a third one has applied to go back to college;
• a woman entrepreneurial support group is being developed at Bay Point in
cooperation with SIT staff and families;
• a Bay Point team member was elected to the Ambrose Park and
Recreation Commission.
cc: SIMT
co Clco
) o o at— CD C> a)
(6 ca U) t, C) 0 CD
U� .4 (D Iqr T- C*A cj V- LO
(4 t.- -4 c c 1� CO (d CO C4
Ni w
tO
LOm
COC7 r 1000 VC-4 -4z (n
I co LO LO
C4 ui ICY! C,4 CD CD C
Cd to CD W LO CO t, U) C
C4 06 c
69 &0 V) V.- T- T-
64 0
E
tU
ctr co r- >
0
w w 07 to C,
C'A OR M* C� C) C's r.- M C-4
4t t- LO V- T- w
RS r LO cm o LO N L'i co 0
V-
6% (D Lo
6% 6-k
O
toCO C>
0) m m Lo
Q1 O Q3 'o C) C4
SZ rui C,4
w im C'A
O C E
4& tA00 EA V V..
LL
O0
tm
rn
tp
Lo
CD a
Q co C) C, C4 Ul Cl C) co co f-
tO N T- N w d' 5 6
(d M f- CO
61.11 CO 6,9LO
C:
0
0) E 0 a)
0m
C: U)
C3 V 0
U- CD E
0
4� — -- a)
a) C U)
L- c -EE �o C: rn
C) 0 C: >1 <D
cn E 00 > E
cn E 0 (D 0 0
cn
0 a) 0 E :E E E E > 'Z-
2 E LL 0 - 0 co (D
E 0 < 0 > -0 U.
L) — C 0
1) cu 75 -
0 0
c a) E (2) c: t!
0
0 0) 0 3: J-- E -0 o 0 C) a) 0)
U) - (1) M . — U) >, U) a-
ca 0
0 E 0- C c
V E W 0 r- a) cu E U) -0 0
0 -C (L) > -0 a) 3:
tL r- 4) a) -0 (1) 70 0 U)
ca r- a) cc r_ (n
0 0
0 0 0 (1) �E -0
m �)- U) =r, a) <
E cn cri (n (n
0 0 - r_ a .2? 0 z .0 0 E 'cu =a) a) 0) a) W Z-' w �o (D
LL x 0) a) o �: 0) — L) U) (0 0 a
-0 0 ca co >1
0 (n < o oo Z ns U U CO a) (n
o o U)
u
c a) a) CD
M 70 0 -r- (9 (D Q 0 C5 x (o
U) < U) LL C �: �: - C: C: (n 0 a) a) a-
>1 LL D < U) 0 M m o C:
c LD cfl
a) co C) (9 —L)
< z 0 .(D D 'C� C: C: :D
.L Lp
-6 LD ca 06
rn
m o a) -6 0 :" c c 2 cc �o
— CD Z Z -6 76 .- — a- -;-- 0 -0
co M M (D a) co
E 0) 483) (OD a) CL cn
cn En U- o m .— c < o E :2 -�; C�
e-% — (L) < < c m (D �5 2
0 (D Z 0 LL M
L) .- — () M �/5 ><
fl
a) LL LL (D (D z 0
0 0 0 0 , , , o E E > - w
0 0 0 - Ca m
o- co (D 0 a) U- LL 0
Z r LI-
0 f-- 0 a) o (D E (D
L) (D 4) -0 — — 'D
0 o A-- E u r_ 0) 0 0 E —0
r- E E E E co E
a) a) a) a) =$ :) z = 2 .2 D - " =3 - 7�5 CM
0) CD 0) 0) c Z c c c c C 0 0 0 W Z 0)
cc co m CL 4) a) 6) M -0 c .0 -0 a) m
0 c: E n3 �a 75 W E E w E W E a")
> > > > m c M 0 0 0 0 16 a) GO) -a) Z :3 3z
0 D >
ca z < < < < ca < w C) z F- F- (L M z z z F- Z 0- <
C: .�O
�'
z �'.
E "
41 gp
ML y
17
a
m
Av
4: —
y a
cc
>
3 Et� C
a s„
co
a PF Orn C
a
k a Q U
-- f °'
s a, MJul �
�.,
cAl
aca
xz,
ca
0
Rf
J � y
0
fA s
r «
3 M .r x N
'7 t M' F-
.: to f/1
r
v
:. O A_ 3,
L
;
UAm.n, .
U
LL v -
w
Q U U a A
a 0 U- (o
QQ f h
o oa b
E LL
N
ir
�-
N
r. Z Z o
E�z
n
� 1
.k l
C)
0 0 cm
O. O _.0..... O O 0 C CD CD N
O W r t0
sgor poule;go oqM slenpinlpul;o jagwnN
70
r--: Kr 'It ti a! oo 'C'
C 0 c a m C14 tD M CN CD U)
LO N N
GO
0) LO
C)
CF) LO
C) 00 to
N04 CO q 04 CD Oi Cl) m
CD C,4 , ct C14 to
GZ, Lo V), 04 co
CO
a)
co a Lo 00 C4 T to w co to co (i
CD 0 t,:
IG T
C)
C4 CR 4
to W 'Tr co (D to to 00 N Co o o ca
C)
Co co q t_: V) a 0 M CO e. C4 C4
(a an M co
N
oz c,
C> CD 90
N 'R fl. . t- '. : " v- LO CIA co C4
Q C) Coo RJ
LO IRT co
C; N N
En
C:
0 cu a
E U0
C)
2i 0
0 LL 0 .(l)
V o !E
U- Elf = +-'< W —
cn 0
0) E
LL U)
0 (D
< - (n
Ln 0 a)
a) 0 — 0 a) in 0
E .0 -0 a) 0 U) to
— a) 0) 0
0 CL c M 0 (n -0
LO " — -�e (U
.r- I_- , 2 , -6 0-
- M 70 E 0) T W LL 0 IL
0 (1) m — -q-
0 C: -
LL -a
E a) m 0 LO Z> W 0 U) CL
.0 w 0 LL (n
E a •
(n -0 w LO E =
uj a — C: :!-: W W C)
E (h U) U) -0
0 _ C: 0 �o — 'D 3: :3 C Q) a
2 a) tf z uj cr-
C7 0 W 'o -0 0 0 n Z
0 0 F C:
0 0 C() U) a)
E o 0 0 =
0 Zo E -c a) Z X 0
.0 0 m Z
X 0) o �r 0) 0
0 Z: z z U) �E
LL 0 0 c 0 z U)
< C) U)
i2 U)
U) -c -r- 6 o <
�o L, 0 3: 3: 0 -C (D
0 —C x
< LL -tr) Z
W cn 0 �: > (1) (1)
a) Z < U) V)
U) 0 LD a) 0-
U)
orn 2
0
M b cuu) u) cn
a) -6 7Fj 0 -0
0 o -T 2 0 06
C) c Cc 0 0
o 0) 6 6 a) :3 (D LL
t r) 2a) -42: MO) Z— X. U- U- 2 70
a)
M LL C) (D 0 < 0 < < Z Z C� U- 0 �o IL (n
M <
(D w w 2
0 Z < 0
C) 2 0 z
a) LL -0 (n LL z — — W
x
0) a) 0 0 o o 0 0 , 0 0 0 W
0 u) E a- 0 0 0 0 0 — D
0
E o (D 0 0 W w 0 a) a) (D Q) 0 CO a) C/)
a) 0
L- E E E E E E 0) E E 0) M
c -r- 0) 0) 0) E —0 0) It z
(D Q) (D ,2 -S § 0) D 0 D D — Z, =3 D , B Z) — — a)
0) ry 0 -0 5, c Z c: C: c cz Z 0 ,
-0 m m cu cu E a) a) a) a) a) 4) m
E — " �) -r- C: C: E M CO 0 0 a -F5 TO- 7-6 -cu 76 E 0
0 4a) (1) — , — — 0 0 Z3 (1)
o L) m 0 = — " — — — — "
> > > 16 (D (1) (1) 0 o 0 o o a) >
z z < < < z 0� Lij c) I z �0- CL n Z 0- <
70
,1
QV
MIN z
Alto 0
7 Its
COT
AMR
F
r
�'.
� 1
{I
IT
t'r 1 a
its
Ann
ASA
VAST
t t k
-1
� 1 r
•- al
:1
r 1 o 121TAII
IRA
� 211 1
Fj ST
1110;Its, j F
I
C1E
O 1
tt
I TAM I TW
r�
t 1 xE x
V - r' al ASCII
- -t l 3 t I
wit1t'
tGUY': °
t n^,k
Z r
1 I 1 M31 list�
i
only! a
-.11 :1 Q ART ' f ,k Z
,
1 i t
•_ I 1 t
F
�+
O t 13 Own
1'
N , 1
1 1
� 1 t
� t
U 1
U11`
D ° .2 1
LL o
O 1
L � � i tgy
�
Q� Q
E WAN
Q L t N
3 3
7 n I i
C F
Z N 1,
a
QW its
I
YU
0 o m
L
E c E m
o � t
"1 z E Z T t ..I 01TTY INA
3€
I k
0
Z
CO
L r
0
01
sqor pauielgo o4M sienpinipuj 10 3agwnN
i
ax -P
C .�D
00 ILO (D
co co
00 Cl)
(q 4 ci cc U-) r— 0) M a (3 CD a) (d
C*4 W C14 C-4 V- LO
m f- q c c 1�- (d oi
QA T r r r Na)
LO m
(0 w
CR cl m It 0 m -tr 00 m LO LO "i
(D CM CO r- 0 0
(,0L- C4 U) L L'i 04
CO 0 -i (6 u) I- to
6% LO 40 La c
60- 0
E
E
co r- 0
(D >
C,4 OR 11) Cl) C*4 0
0) C, cl CD C>
m W) C'I M Lo r- LO C,4 ul ul to d
6F, w in Lo I- co .0
O
to w.
0
a
m
C.0
C') cl cclo LCD,
a) "P
C> M Lo CIA co (i
O IIR 4D T- C� N 0
(D C� C-4 rl v V- V-
69 'r- ti t,� ci E
LL 03, t2�tF* V-
0
07 tt Lo
lao, 1.10
C) CD cq C> 0
C14 r.- CD r- a co co Cl Ctf ci
m r-- C*4 C14 to -q Cl
to COEf# to
6F)
iv
Ll
U- co
-C
-C W
I
a) 15- C m to
o
co (D E a) c
0 4D --, — o > E
(D
cn 0 E E 0 W
0 0 E Ch !E E w E > 0 0
E E LL
0
o < 0 — 0 > Q
CL C: 41 C: c L.
45 0 a) a) V) C -r- 0
c (D a) o E a) o
0 zi 0
U) 0) a ., _3: -r- E 12
a) cu 0 to >, 0 0 (D 4)
E C: — M -0 (0 0 — 0 U)
to 0 r 'a o o
W 4) u cn A--
cu a) E C C)- 0 .�L) r- U) "o
W a) Lo c _r_ a)
E f-- (0 0
0 >
(D
0
c
-,z 0 a) -0 0
E cu - E =(D C
0 0 --F; a) <
LL X 0) z
0 o 3: cn
Q 0 o E o Zc
— m 0 0
0 < C:
0 cn
LU LL C) M 0 (D
LL (U 0 0 x
w 0 0 �: 3: t a c (n ca
M >, LL < M Co a) -Z- = C
0 (D c c cc
C;) < Z t 7Z3 L) -0 L) .2
4- = (L) (1) (D (1) (D d) 0 r- M ((
C) c) m o2 4) (L) C) z Z 4- - ooh Q
Q 0 CM C c U) 0 Cl)
F- . Z Z Z 'U (1) (D m U)
cl) LL E (u U) E
C) cc c (
0 < < oQQ ZZ cn
(D Z (D '5 2
H ad
C: o < '0 U- to a.
(n 0 co
F- a, LL — -- (D 0 0- F/) x
< 0 -6 a) b 0 b o E >
Z E a_ M M LU
cu.,:� a) -- 0 0) U- U- U- U) 0 co
N CL �o -0 _0 .0 �o a) 0 a
0 0 .c E xL-) c E E E E 0) cy) 0) E o o '0 E z
c c c �6 a) z c 0)
c Z C: C: a)
c: c E E E w E E
- :3 2) 2) 2 — 0
> > > > co c cu 0 —0 —0 16 "5 a) D D m z
z 0) (L) 0 a) >
< < < < co < w () F- CL IL CL z z 3: z z (L <
fl o o . 70
I-0
CFI-- V- .t 'r- -,t r, 00 a
CLSO c c vi N 6 Nr m to
U, ca
C4 C4
Im 'IWOr-
a! M C4 ,t CRT N COM CA co a a w Lo o ci
Cp m
W C4 w
CD
CD a 'm
r- co
in C� C>
r-
C> W
0
w w 'cr co cy to o o r Oa co CO
U- go M
4A 6%
to
CD a
Cl R 1. .1
O a 0,
C4 P- . 1- 1. .1 -r- W a W Lo �O- (i
to C� m
c� C> m ti
w ci ci C4 m CO co
0
E C) 0
15 0
LL
LL
0 iE
< cr-
0) C) W 0 .
a) E T)
to
2
0 < 4) E 0)0 a) >% - 0 0 cn
.o C: 0
— — (n E
0 :E . E E (D (n 0
a)
0 70 z
W
0 0 1B (D 2i 2
c
E aaW)) 6cB LL 0
o N 0 L C >1 =
0 E cr-, 0 a)
LLE UJ 0 U) C)
.0 w a) 0 0
-0 -C s E 0. 0 U-
(D E C: m w Lo E -c tf DL fY fA U) -0
w -C 0 C 0
2 c - *� — -0 Z UJ [If a)
E m 0 S� =
:3 U) z -0 0 U)
m 0 a) C) o
4� 0 (-) i--
0 c 0 c D U) Cl) a) -0
E c: a) o (.) = <
0 LD z 0 - = Z co
2
0 Y) o LL Z
m < o o o z C: U) C
- 0 < (D -C -'e 43)
0 U) o U) Q> C) cn =
V) LL 'A n o 3: t 0 (D
LL w to (1) C: X
lz Z 0
(1) a)
cl -0 (n (n M
a) j5 7t5 o CL
(1) L)
:E Q) 43) c - -4--
z C) 0 5
t3 UM c cu
0 cCi
—0 0) (D (n 2 o -a 06
o
(D C) U- LL 0 c cu
cm U- E CL K — — " - a)
cu C) o < < T LL F- -o C"L
CL a) D
0 Z < 0 w w -E M (D z
LL (n 2 U. z W
< a) o o o 0 0 0 0 uj
3: 0 .(n E IL 0 0 0 0 0 0
0 a) - — �5
0 E C) o a) a) 0) a)
0 E to _0 0 0 0 W -0 �c w -0 .o 0 E n — (D 0
cu 0 E E E 0) 0) 0) E E E E E 0) *
cm 0) 0)m m (U 0) 0 -0 0 5, z c 0)
ca c .0 0 a) cu
E
E - - C: E 76 m 'Fu 'Fu 0 m m 0
0 a) a) a) a-) E =) — — — E 2 (—D
3 > > > > o cc o 0 0 0 0 o 0 0 W 7�5 �5 (D _0 a-) 0 = a)
z z < < < < z w LU 0 Z 1 0- a- 0- CL a- z CL
CONTRA COSTA COUNTY
OFFICE OF THE COUNTY A DMINIS TRA TOR
651 Pine Street, 10th Floor
Martinez, California 94553
Telephone: (51 1) 646-4154
Fax: (510) 646-1353 -
TO: Sara Hoffman
FROM: Nina Goldman
SUBJECT: RISE Initiative (formerly known as RV/RC/CA-7) Waiver Request
DATE: July 5, 1996
Attached is a revised draft copy of the "Re-investing In Self-Sufficiency and Employment"
(RISE) waiver request. Chris Linville and I had an extremely productive three days in
Sacramento working with the State Department of Social Services on revising the RISE
Initiative draft. We received extremely positive feedback from virtually everyone we met
with during our time there -- including staff from the Food Stamps program, the AFDC
program, Employment programs and the Cost Estimates Bureau. As you know, the Fraud
Bureau has already indicated their support of the request. Karen Kennedy, who is
coordinating our work with the State, said she believes that we can get a signature from
Eloise Anderson by the end of July. At that point, the request would be sent to the U.S.
Department of Health and Human Services for federal approval.
The effect of the request will be that AFDC and Food Stamps recipients served by the SITs
will only need to file monthly CA 7s when they experience a change and/or if they have
earned incomes. We estimate that this change initially will eliminate approximately two-
thirds of all CA 7s filed each month. In addition, the request calls for a modified and
notably less complicated redetermination (RD) process. Clients will be required to fill out
a short form similar to the one shown in Attachment A of the waiver; in addition, the RD
process will provide SIT EWs an opportunity to work on self-sufficiency issues with clients.
The RDs will take place semi-annually. Because they will be so much shorter than the
RDs we currently conduct, the total amount of time spent on RDs will be about equal to the
present. A crucial component of the RISE Initiative request is that it asks that EWS be
allowed to reinvest the time saved through the elimination of"no change"CA 7s in activities
aimed at promoting the self-sufficiency and family stability of AFDC and Food Stamps
recipients.
I hope to hear back from the State within the next several weeks and will update you on
our progress.
cc: STMT
North Richmond and Bay Point SITs
Ms. Mary Jo Bane, Assistant Secretary
Administration for Children and Families
U.S. Department of Health and Human Services
370 L'Enfant Promenade, S.W.
V.'ashington, D.C. 20447
Dear Ms. Bane:
Enclosed is California's Reinvesting in Self-Sufficiency and Employment{RISE}+��ei"ative
proposal pursuant to Section of Title 42 of the United States Co�e�Wesk that this
proposal be reviewed and approved as soon as possible. fl
'
This demonstration project is a part of California's strate 6"' Ian to ,out�" es for
children and families, as outlined in State Assembly Bila) 1741 8 174 , rues six
California counties to pursue federal waivers in support he i „_ ementation oinin Vit. `e
strategies at the local level to provide comprehensives ;'p e children and fa f i Ne he
purpose of this proposal is to eliminate non-productive andup ieative activities in alifornia's
AFDC program in favor of activities aimed at promotingpersonaI" onsibility, workforce
attachment and supportive services leading to family stabilit raid self*sufficiency.
In the RISE Initiative, monthly reporting/retrospects e1 e 'geting is replaced by "timeframe"
reporting/retrospective budgeting for non eased comeDC,case nd annual
redeterminations are replaced by semi-anriual, m01 ode edetermm Yons for all AFDC cases in
Contra Costa County, California. Timefra= e re'poilfng owm' 4s. a best aspects of both
"monthly" reporting and "change" repor i g into �asily a I e, more efficient and effective
model for reporting and processing�aiges iri e AFDCogram. The savings accrued
through these changes are reinves�ed�n suc."tt tivities as intensified job placement and
retention services, accessing co fal
unity resources andacking the results of this innovative
service strategy. This proje w Its est whether a indreased emphasis on activities that
strengtherkit- -flies throu c n othi ppot 8services will increase the number of AFDC
recipient# loy duce bo -term and long-term AFDC dependency.
We are eag�ei� o with yo _x tori tall to obtain approval of this proposal.
Im cementation o � :
p r` a onstraft� rksject is targeted for January 1, 1997. We are currently
wanking clan .i: t `; pn#Aosta CcI ty on building local capacity to implement this plan. We
look forwar` o what e-believe vvilI be an exemplary Federal, State and County partnership for
improving the well-beingof chirn and families.
01
Wew uld like to discuss y concerns you may have regarding this proposal as soon as
p ssble. Questions sh Id be directed to Bruce Wagstaff, Deputy Director, Welfare Programs
Division at
Sincerely,
� 3
Eloise Anderson
Director
4
.REINVESTING IN SELF-SUFFICIENCY AND EMPLOYMENT (RISE)
INITIATIVE
I. FEDERAL LAWS AND REGULATIONS TO BE WAIVED
35111-1-
II. QUALITY CONTROL HOLD HARMLESS
III. COST/SAVINGS INFORMATION �m
TATE,
A. PROJECT COSTS AND SAVINGS (FEDE s,\ CO N u i
f .w
B. EVALUATION COSTS ` ``' �`
IV. PROGRAM NARRATIVE .
A. PROJECT TITLE ; #
B. INTRODUCTION _
C. OPERATIONAL TIME FRAMES '
D. PROJECT PARTICIPANTS
E. BACKGROUND AND IMPORNCE UFI �E
s.
F. PROJECT COMPONENTS
AND DEMO ,RATIO, METHOD b Y
Objectives �\
G. RESEARCH � s;
i. �n
ii. Hypothese's$
Mea a gents
a �E
4 ky Y
V. M��F 'u"', OLOG�C . !°►TIO �PtAN
to to0,1 acted
ectlon N et ods
I`l raaly�IcaI m thodology
iv. �r'iental Design
VIS , WORK PLAN
hRP
V[ REPORTS
V11I PO CT STAFF AND FACILITIES
A. PROJECT OVERSIGHT
B. PROJECT MANAGER
C. PROJECT LOCATION
x . 70
REINVESTING IN SELF-SUFFICIENCY AND EMPLOYMENT (RISE)
INITIATIVE
1. FEDERAL LAWS AND REGULATIONS TO BE WAIVED
[TO BE DETERMINED WITH CRSS]
11. QUALITY CONTROL HOLD HARMLESS
The changes contained in this proposal will improve the effectiveness and
efficiency of the AFDC program. However, the changes may have a short-term,
temporary, inflationary effect on the quality control (QC) error rates during initial
project implementation. The County plans to offer comprehensive staff
f training
and information on the changes that will take place to minimize the probability of
increased error rates. Any effect of the RISE Initiative on error rates will not impact
the State's QC error rate, because of the small number of cases participating in
this project.
However, in acknowledgment of this potential effect on the State's QC error rates,
and to avoid penalizing the State for initiative in improving its public assistance
programs, we request a OC hold harmless period during the implementation of the
project. Specifically, we propose to review the new project requirements
beginning with their effective date. We would identify and report eligibility
.determination errors discovered during the reviews. However, the errors made in
the changed program areas specified in this proposal would be deleted from the
calculation of California's official rates during the first 12 months of
implementation.
Ill. COST/SAVINGS INFORMATION
A. PROJECT COSTS AND SAVINGS (FEDERAL, STATE, COUNTY)
Contra Costa County estimates that this project will result in savings to the
Federal, State and County governments. The savings primarily would accrue from
avoided AFDC benefit payments as welfare recipients move more rapidly from
welfare to work. In addition, savings may accrue due to avoided Food Stamps and
Medi-Cal benefit payments.
[NEED ESTIMATES OF SAVINGS -- TALK WITH ESTIMATE FOLKS AT CDSSI
In terms of administrative costs, this project will be cost neutral. If granted, this
waiver will redirect funds saved through more efficient administrative practices to
activities aimed at increasing clients' economic self-sufficiency. Thus,
administrative savings would be reinvested into direct client self-sufficiency
support activities. Ultimately, administrative savings also may accrue as more
clients become self-sufficient and the County's AFDC caseload decreases in size.
B. EVALUATION COSTS
[TO BE DETERMINED WITH CDSS]
IV. PROGRAM NARRATIVE
A. PROJECT TITLE
REINVESTING IN SELF-SUFFICIENCY AND EMPLOYMENT (RISE) INITIATIVE
B. INTRODUCTION
A significant portion of Federal, State and County administrative AFDC dollars in
California are expended on the processing of non-productive and often duplicative
paperwork, rather than on productive activities aimed at helping AFDC recipients
achieve family stability and economic self-sufficiency. The RISE Initiative
demonstration eliminates non-productive and duplicative activities in California's
AFDC program in favor of activities aimed at promoting personal responsibility,
workforce attachment and supportive services leading to family stability and self-
sufficiency.
The RISE Initiative demonstration is a part of California's strategic plan to improve
outcomes for children and families through comprehensive service initiatives, as
outlined in State Assembly Bill (AB) 1741 . AB 1741 authorizes six California
counties to pursue state and federal waivers in support of the implementation of
innovative strategies at the local level to provide comprehensive services to
children and families. f
Contra Costa County, with its Family Service Center model, is among the six AB
1741 pilot counties. The Family Service Centers serve families and children
receiving public services from three or more public programs (including AFDC, Food
Stamps, Medi-Cal, Greater Avenues to Independence, Public Health Services,
Mental Health Services, Child Welfare Services and/or Probation Services). A
fundamental element of the Family Service Center model is the premise that
strong, stable families have a greater capacity to obtain and maintain economic
self-sufficiency. Contra Costa County's AB 1741 pilot takes a cost-neutral
approach to improving the well-being of children and families through the
reinvestment of resources saved by increasing program efficiency and
effectiveness.
In the RISE Initiative, monthly reporting/retrospective budgeting is replaced by
"timeframe" reporting/retrospective budgeting for non-earned-income AFDC cases and
annual redeterminations are replaced by semi-annual, modified redeterminations for all
. 70
AFDC cases in Contra Costa County, California. The savings accrued through these
changes are reinvested in such activities as intensified job placement and retention
services, accessing community resources and tracking the results of this innovative
service strategy.
By reducing duplicative paperwork and focusing on productive staff and client
activities, the RISE Initiative seeks to achieve the following objectives:
To increase the number of AFDC recipients with earned income.
To increase the number of families who exit AFDC due to an increase
in employment/earnings.
To increase the stability of families on AFDC by providing them
access to supportive servicesthrough an integrated service delivery
model.
This project will test whether an increased emphasis on activities that strengthen
families through work and other supportive services will increase the number of
AFDC recipients with employment and reduce both short-term and long-term AFDC
dependency.
C. OPERATIONAL TIME FRAMES
The State of California and the County of Contra Costa have designated January 1,
1997 as the target implementation date. It will be necessary to receive waivers of
pertinent federal laws and regulations by November 1 , 1996 in order to meet this
target date.
The RISE Initiative will operate in one California county through December 31,
2000. The end date for the demonstration project coincides with the sunset date
of AB 1741, the State legislation that designates Contra Costa County as one of
six California "youth pilot project" counties.
Implementation of the RISE Initiative demonstration is subject to federal approval
to obtain the waivers necessary to conduct this project.
D. PROJECT PARTICIPANTS
The RISE Initiative will be conducted in the County of Contra Costa. Contra Costa
County is home to approximately 18,000 AFDC recipients less than 2 percent of
California's total AFDC population.
rvdraft.do.c, 7/2/96, P.3 3
6 .70
The demonstration project will be implemented incrementally. Initially, project
participants will be limited to approximately 1,100 AFDC recipient families, living in
two low-income communities in Contra Costa: North Richmond and Bay Point.
Over the the life of the project, the Family Service Cei'iter model may be expanded.
The communities potentially designated for Family Service Centers are other
distressed communities in Contra Costa County. These communities hk
.ye far
higher rates of poverty, unemployment and teenage pregnancy and far lower rates
of educational attainment than does Contra Costa County as a whole (see Table 1).
E. BACKGROUND AND IMPORTANCE OF THIS PROJECT
Assembly Bill (AB) 1741, enacted in September 1994, authorized the California
Health and Welfare Agency (HWA) to approve projects in six California counties as
pilots for testing the effectiveness of comprehensive services to improve results for
high-risk, multi-problem children and families. The legislation authorized HWA to
work with the six pilot counties to obtain Federal waivers necessary to achieve
their results. As a result of this mandate, County staff have worked closely with
HWA and California Department of Social Services (CDSS) staff to identify pilot
barriers. Together, State and Contra Costa County staff identified the need for
Federal waivers in the AFDC program to achieve the pilot's goals, resulting in the
development of the Re-investing In Self-Sufficiency and Employment (RISE)
Initiative.
The RISE Initiative strives to increase the efficiency and effectiveness of services
to AFDC recipients by:
Increasing Program Efficiency
As the resources for administering public assistance programs grow increasingly
scarce, it is crucial that these programs be run as efficiently as possible. Benefits
must be administered in as accurate and timely a manner as possible, without
duplicative and unnecessary. paperwork. The RISE Initiative would dramatically
increase AFDC program efficiency by:
(1) , eliminating the processing of "no change" monthly reports; and
(2) eliminating the need to suspend and reinstate cases where benefits
have been terminated due to failure to report monthly, even though no
change in circumstances occurred.
Under the curent rules, eligibility workers spend a significant portion of their
working hours performing duplicative and non-productive activities. The intent of
the current monthly reporting, retrospective budgeting and annual redetermination
rvdraftdoc, 7/2/96, PA 4
e .10
x
N 0 0 rn Cl)
R
( s: co r
1 x
R (� Co O O O o7 r
E ",•,y tf') m CO co LO r
O M
r N N r r
x
0-
N-
0NT-
_. N (D M "a; O
O M f
r
co
.� � h (p
O U)
(n V
w
N
.� o
C/) B 0 0 0 to
W � '- O cg o
E► 4 M r r
� r M
O (q m
U Ix c
L W x
x
Z = a? Cl) 0 0 0 v r-
a) iU O = Cts N N t�
U U hl 'T chi r-Ott
r M Cr r
N W r
U x .
` x
C
N W O a�~o o u3
U) c/? o N: cli i v
M r
E a
cu x
Q
�. o a o
O N O r
Ql V CN ~ CDN co LO
ui
0 �- r
U- x
.O
r p O 0 0 o— 00 co d
00
cc O = co O til C6 r
Z O N LO W) N
a) w
LL
� x M o 0
co
Nr
N N O
00 °O �. M
i 83 d1
U (Oj c 0 ocu
R r" co r cO
O p h d ��
O C U 06 o U
U U
E (0
a a>
O d p r
O 3 o $ s 0) Z
E 41 d = V7. = 0 i O d
O > O U) 4) }CO (n O O {i7
r' L O ca c IL M Z N d Q O R O q m V7
N s c ' c E p CL `v r m � _
a _ o _O 0 E � 4a o
cu Q L '� L w fl. +I O 4) O O G.
O 4) d ._ R = = cm C O = 0 4)
x . 70
(RD) process is to ensure on an on-going basis that only eligible assistance units
receive AFDC benefits and to ensure that eligible families receive accurate levels of
AFDC benefits on a timely basis. Currently, eligibility workers evaluate continuing
eligibility and benefit levels based on requirements that AFDC recipients report all
changes affecting eligibility and benefit levels via the following three processes:
(1) the monthly reporting (CA 7) process (AFDC households must complete a
monthly eligibility and income report form);(2) the change report process_'AFDC
recipients must, in addition to monthly reporting requirements, report changes
within five days of the date changes occur); and (3) the redetermination (RD)
process (annually, for all AFDC recipients).
Because the monthly reporting process requires that a CA 7 be filed each month,
even when no reportable changes in circumstances has occurred, eligibility workers
spend a significant amount of time on non-productive processes: receiving,
opening, sorting, reviewing and filing CA 7 forms that report no changes, including
suspending and resinstating cases that have been discontinued due to failure to
submit a complete CA 7. Contra Costa County estimates that the typical eligibility
worker, with an average caseload of 180 AFDC cases, spends 20 minutes
processing each CA 7 (this includes time spent not only in processing changes, but
also in returning incomplete CA 7s, suspending cases for incomplete/nonreceipt of
CA 7s, Balderas contacts, withdrawing suspends and rescinding discontinuances
related to CA 7s). Processing monthly CA 7s consumes approximately 60 hours
per month, or 720 hours per year per eligibility worker.
Approximately two-thirds of all CA 7s currently submitted by AFDC recipients and
processed by AFDC eligibility workers state that no changes affecting eligibility or
benefit levels have occurred in the reporting period. Based on these estimates, the
typical eligibility worker spends approximately 480 hours per year, or 23.1 percent
of his/her working time, receiving, opening, sorting, reviewing and filing forms
which report that no changes. There are also costs associated with the
purchasing, storage and mailing of the materials.
Increasing Program Effectiveness
The RISE Initiative strives to increase the effectiveness of the AFDC program at
increasing the family stability and economic self-sufficiency of AFDC recipients.
The RISE Initiative rests on the belief that family stability is a necessary corollary to
sustained economic self-sufficiency. Experience in a number of state and county
programs indicates that activities aimed at promoting personal responsibility,
workforce attachment and supportive services lead to higher employment rates of
AFDC recipients. The RISE Initiative will test the hypothesis that the re-direction
of AFDC program staff to perform these types of activities will increase the
stability and self-sufficiency of high-risk, multi-problem AFDC families as evidenced
by outcome measures such as: the number of AFDC cases with earned incomes
and the number of AFDC cases terminated due to employment/earnings.
rvdraftdoc, 7/2/96, P.5 5
Underlying this hypothesis is the belief that increased and more productive fa6e-to-
face contact with clients will allow eligibility workers to work effectively with
clients to achieve and reach their self-sufficiency goals. The RISE Initiativeproposal
recognizes the face-to-face RD process as a valuable opportunity to perform case
management activities. Thus, Contra Costa proposes to expand the RD process
into an opportunity for eligibility workers to work directly with AFDC recipients at
setting and reviewing self-sufficiency goals, planning the means to achi'Qve these
goals and monitoring progress in achieving the goals. By moving from an annual
RD process to a semi-annual RD process, with a modified and simplified paperwork
component, eligibility workers will be able to work more closely with clients and
provide more support in their transition to self-sufficiency.
Serving as a Model for California
Demographically, Contra Costa County represents a microcosm of the State of
California. [INCLUDE STATISTICS, PIE CHARTS, ETC.] Because of its demographic
diversity, Contra Costa is in the unique position of serving as a strong testing
ground for innovations that are under consideration for Statewide replication.
F. PROJECT COMPONENTS
The RISE Initiative consists of five key components:
(1) Timeframe Reporting/Retrospective Budgeting for Non-Earned-Income
Cases;
(2) Monthly Reporting/Retrospective Budgeting for Earned-Income Cases;
(3) Semi-Annual Redeterminations;
(4) Statement on the Back of the AFDC Check; and
(5) Reinvestment of Savings towards Productive Activities Aimed at
Promoting the Family Stability and Economic Self-Sufficiency of AFDC
Recipients.
The project components are described below.
(1 ) Timeframe Reporting/Retrospective Budgeting for Non-Earned-Income Cases
Timeframe reporting/retrospective budgeting (TR/RB) would replace monthly
reporting/retrospective budgeting (MR/RB) for all non-earned-income AFDC cases.
TR/RB cannot be categorized either as "monthly" reporting or as "change-
reporting, according to the specific definitions of each system; rather, TR/RB
rvdraftdoc, 7/2/96, P-6 6
6 -70
combines the best aspects of each process into an easily adaptable, more efficient
and effective model for reporting and processing changes in the AFDC program.
In TR/RB, the five-day reporting rule is retained. In addition, all TR/RB cases
receive a CA 7 on the first of the month. It is to be returtied only if a reportable
change occurred in the budget month. The return cycle is the same (due by the
fifth, late after the 11th, etc.). If a change was reported via the five-day process
and no CA 7 is received, the suspend process applies. The suspend process
applies also for incomplete CA 7s. For cases in which no change occurred in the
budget month, the payee's signature on the benefit check confirms this fact and
no CA 7 is required (See "Statement on the Back of the AFDC Check" below).
TR/RB is like"MR/RB in that a monthly CA 7 must be filed for the month in which
the change occurs. All other reporting rules, and rules for processing changes, are
the same as in the current monthly reporting system. Retrospective budgeting is
retained.
What TR/RB accomplishes is the elimination of monthly CA 7s for cases in which
no reportable changes in household circumstances occurred in the budget month.
(2) Monthly Reporting/Retropsective Budgeting for Earned-Income Cases
All cases with earned income are subject to MR/RB. The five-day reporting rule
and the retrospective budgeting system are retained. The current reporting and
budgeting process and the process for reporting and acting on changes remains the
same for earned-income cases.
(3) Semi-Annual Redeterminations (RDs)
A modified RD, with a face-to-face interview, will take place semi-annually (every
six months) for all AFDC cases. This process will serve two purposes:
Preserve program integrity and ensure that ongoing eligibility and
benefit levels are correct.
Conduct case-management activities in the semi-annual face-to-face
interview. Eligibility workers will also use the RD process as an
opportunity to complete a self-sufficiency assessment and progress
review with clients.
A draft copy of the modified RD form is attached (See Attachment A).
(4) Statement on the Back of the AFDC Check
rvdraft.doc, 7/2/96, P.7 7
70
As the result of in-depth discussions with State and County legal and fraud
prevention staff, Contra Costa County has designed a new version of the AFDC
check provided in Attachment B. The new AFDC check includes the following
statement above the recipient's endorsement signature:
By signing my name below, / hereby state that either (1) no changes have
occurred in my circumstances that affect the amount of this chei:* OR t2)
have met my responsibilities to report to the County my earned income
and/or any changes in my circumstances that could affect the amount of
this check. / certify under penalty of'perjury under the laws of the State of
California that the foregoing is true and correct.
Payee Sign Here:
Statements describing the reporting responsibilities of the AFDC program are
attached to each AFDC check in English and Spanish. Other language translations
will be available by phone.
This redesigned welfare will provide evidence each month that clients understood
and met their reporting responsibilities, without imposing the additional
administrative activities of no change CA 7s. In addition, the information sheet
attached to the check will ensure that all AFDC recipients receive monthly
explanations of their reporting responsibilities.
(5) Reinvestment of Savings towards Productive Activities Aimed.at Promoting
the Family Stability and Economic Self-Sufficiency of AFDC Recipients
As stated above, Contra Costa County estimates that the elimination of monthly
reporting in favor of change reporting will result in significant time savings per
eligibility worker per year. The RISE Initiative will reinvest this time saved towards
productive worker activities aimed at promoting AFDC recipients' stability and self-
sufficiency.
Specific activities that workers will perform include both activities aimed at
promoting employment and activities aimed at increasing family stability.
Activities directly aimed at promoting employment and economic self-sufficiency,
including but not limited to:
Working with AFDC recipients to identify their employment skills and
goals and formulating strategies for achieving these goals.
93 Conducting orientations and workshops where AFDC recipients: learn
about how they can achieve higher economic standards of living by
rvdraft.doc, 7/2/96, P.8 8
e .10
having an earned income ("Work Pays" information); build their self-
esteem; learn basic job searching techniques (including cold calling
and job interviewing); complete resumes and job applications and gain
access to resources in the community that can, help support their
quest for self-sufficiency.
Providing on-going case management support to AFDC__recipients
searching for employment.
Collaborating with public programs and community-based
organizations that conduct employment services to facilitate the
referral of AFDC recipients and placements in programs that can
increase employment and/or family strength and stability.
Providing short-term support to AFDC recipients who have obtained
employment and need assistance surmounting obstacles that threaten
their job status.
Activities aimed at promoting long-term family stability, including but not limited
to:
Referring clients to stable, affordable housing and programs aimed at
helping clients establish savings accounts.
93 Referring clients to affordable health care (including CHDP,
immunization clinics, dental care, optical care, pregnancy testing,
family planning) and helping them to set up appointments.
13 Referring clients to affordable child care programs.
13 Screening clients for substance abuse problems and mental health
problems and referring them to treatment, as needed.
13 Conferring with professionals from other county agencies, schools and
community-based organizations regarding common clients,
coordination of related activities and joint projects.
Advantages of the RISE Model
13 TR/RB eliminates duplicative and unproductive aspects of the monthly
reporting process, in which up to two-thirds of all CA 7s certify no changes
occurred in the budget month.
rvdraft.d.oc, 7/2/96, P.9 9
6 . 70
13 TR/RB avoids the program integrity concerns of a change reporting system
by retaining retrospective budgeting and continuing to provide CA 7s to
clients on a monthly basis (with stuffers that remind clients of their monthly
reporting responsibilities) and warnings that the signature on the back of the
check carries tne same penalties for fraud as the signature on the CA 7).
The RISE model provides for semi-annual rather than annual R.ds,,,vyh ich both
enhances program integrity and provides increased opportunities to conduct
activities aimed at promoting AFDC recipient self-sufficiency.
13 Because five-day reporting and retrospective budgeting are retained for both
TR/RB and MR/RB, there is a seamless transition between the two processes
when earned income starts or.stops.
The RISE model accomplishes a positive change (the elimination of no
change CA 7s) without increased cost, need for retraining staff, changes in
computer systems or extensive process revision.
G. RESEARCH AND DEMONSTRATION METHODOLOGY
i. Proposal
Establish timeframe reporting/retrospective budgeting to determine 'ongoing
eligibility and benefit levels for non-earned-income AFDC cases.
13 Establish semi-annual modified reinvestigations for all AFDC cases.
Establish the following program integrity insurance measures, including: (1)
statements on the back of AFDC checks (see Attachment B);,(2) semi-
annual face-to-face contacts between eligibility workers and AFDC
recipients; (3) more frequent use of the automated statewide MEDS system,
the statewide Integrated Fraud Detection (IFD) system, the Income and
Eligibility Verification System (IEVS), the Systematic Alien Verification for
Entitlement (SAVE) System and the Early Fraud Detection Program (EFDP).
ii., Objectives
The RISE Initiative seeks to achieve the following objectives:
[3 Reduce paperwork.
Redirect eligibility worker tasks.
rvdraft.doc, 7/2/96, P.10 10
70
Increase the economic self-sufficiency of AFDC recipients.
Maintain or enhance program integrity by meeting federal and state
requirements for eligibility determinations in an efficient, correct and timely
manner.
iii. Hypotheses N._
The RISE Initiative will test the following hypotheses:
Accurate information affecting eligibility for benefits can be obtained more
efficiently through a combined TR/RB and MR/RB and semi-annual, modified
RD process than through a MR/RB and annual RD process.
The redirection of eligibility worker efforts away from no change CA 7s and
overly cumbersome annual RDs towards activities aimed at increasing the
self-sufficiency of welfare recipients will lead to a higher number of AFDC
recipients with earned incomes, a higher number of persons who leave
AFDC due to earnings/increased earnings and greater stability of AFDC
families.
There will be no significant increase in the Quality Control error rate
attributable to the replacement of MR/RB and annual RD process with a
combined TR/RB and MR/RB and semi-annual, modified RD process.
iv. Measurements
[3 Quality Control error rates preceding implementation of the demonstration
project.
[3 Quality Control error rates for demonstration project pilot during the length
of the project.
Percentage of AFDC recipients with earned incomes preceding
implementation of the demonstration project.
K3 Percentage of AFDC recipients with earned incomes during the length of the
project.
[3 Percentage of AFDC recipients terminating aid due to earned incomes
preceding implementation of the demonstration project.
[3 Percentage of AFDC recipients terminating aid due to earned incomes during
the length of the of the project.
rvdraft.doc, 712196, P.I I
Ratio of AFDC-Unemployed Parent (AFDC-U) recipients to AFDC-Family
Group (AFDC-FG) recipients preceding implementation of the demonstration
project.
0 Ratio of AFDC-(J recipients to AFDC-FG recipients during the length of the
project.
I. METHODOLOGY/EVALUATION PLAN
i. Data to be collected
Independent Variables:
1) Number of months in a year AFDC is received
2) Length of receipt of AFDC
3) Birthdate
4) Gender
5) Education status
6) Family structure
7) Number of offspring in the home
8) Age of offspring in the home
9) Race/Ethnicity
10) Receipt of GAIN services and length of reciept of GAIN services
1 1) Length of time served by the Family Service Center
12) Employment history
Dependent Variables:
1 ) Number of AFDC clients with earned income
2) Number of persons leaving AFDC due to earned income
ii. Collection methods
Independent Variables:
The independent variables will be collected on a monthly basis. Information
will be acquired from the automated. Case Data System and the GAIN
Information System in the form of monthly reports. Information in the case
files will be collected manually and recorded.
Dependent Variables:
The dependent variables will be collected in the form of monthly reports
from the automated Case Data System and the GAIN Information System.
rvdraft.doc, 7/2/96, P.12 12
42 -70
iii. Analytical methodology
Several analytical methods will be used in this evaluation to examine the
hypotheses. The unit of time in this evaluation will be the calender month.
Descriptive statistics will be used to track changes in AFDC recipie"I'lt employment
and termination from AFDC due to earned income. The intent is to describe earned
income rates for the baseline year, each month during the duration of the_
evaluation and at the completion of the study. An AFDC recipient employment
analysis series.will be conducted.
During the two months prior to implementing the RISE Initiative, the County will
conduct a time and motion study to determine the amount of time spent by staff in
conducting redeterminations and the amount of time spent by staff in reviewing
monthly reports according to the procedures regularly used prior to implementing
the .RISE Initiative. This study will be repeated, at a date agreed upon by the State
and the Department of Health and Human Services, to make the same
determinations under RISE Initiative procedures. The objective of these studies is
to provide information on whether the time saved under the RISE Initiative is
sufficient to achieve the RISE Initiative goal of redirecting eligibility worker time
towards activities aimed at promoting the family stability and economic self-
sufficiency of AFDC recipients. The data from these 'studies will be used in the
impact and process evaluations of the demonstration.
iv. Experimental Design
The hypotheses will be tested through use of a classical experimental design.
V1. WORK PLAN
7/15/96 Formal waiver request to Department of Health and Human Services
(DHSS)
11/1/96 Waiver approved
1/1/97 Target implementation date
1/1/97 Begin tracking for evaluation purposes
4/30/98 Annual report covering 1/1/97 through 12/31/97 to DHSS
4/30/99 Annual report covering 1/1/98 through 12/31/98 to DHSS
4/30/00 Annual report covering 1/1/99 through 12/31/99 to DHSS
rvdraft.doc, 7/2/96, P.13 13
C .70
12/31/00 Project ends
4/30/01 Annualreport covering 1/1/00 through 12/31/00 to DHSS
6/30/01 Final evaluation to Dr-ISS
VII. REPORTS
Annual reports and a final report will be submitted by CDSS to the Department of
Health and Human Services.
Annual reports will be submitted to the department four months from the end of
each 12 month period. The reports will include summaries of past reports;
changes that occurred since the last annual report, cumulative changes from the
baseline data, and estimated savings for the year and since implementation of the
project.
The final report will be provided to DHHS six months from the last day of
participant tracking. The report will include a summary of the findings, an
evaluation of whether the project met its stated objectives and a discussion of
California's plan for future implementation of the findings.
VIII. PROJECT STAFF AND FACILITIES
A. PROJECT OVERSIGHT
Oversight of the project will be the responsibility of the CDSS AFDC Program
Branch. Organizationally, the AFDC Program Branch is within the Welfare
Programs Division of CDSS.
B. PROJECT MANAGER
The Project Manager will be Nina Goldman, Service Integration Specialist, County
Administrator's Office, Contra Costa County. The Project Manager will be
responsible for all project coordination activities. This will include coordinating
communications between the CDSS and Contra Costa County Social Services
Department (CCCSSD), dissemination of information and materials to conduct
project, coordination of automation activities necessary to implement the RISE
Initiative and coordination of evaluation and research activities.
C. PROJECT LOCATION
The location of the project will be:
rvdraft.doc, .7/2/96, P.14 14
. 70
Office of the County Administrator
651 Pine Street, 10th Floor
Martinez, California 94553
rvdraft.doc, 712196, P.15 15
x. .70
ATTACHMENT A: MODIFIED SEMI-ANNUAL REDETERMINATION FORM
[WE USE TEXAS' FORM AS AN EXAMPLE,UNTIL WE DEVISE OUR
OWN]
rvdraft.doc, 712196, P.16 16
C .10
Texas department of Human Services Form 1010/9-94
AGENCY USE ONLY/PABA USO DE LA AGENCIA,
Status E)App. ❑RecerL pp./Case No. Date Requested—T te Mailed Date Received Date Received by Wrong Office
—
Former Recipient? BJN Mail(Code Elig.for Exped.Serv.? Screened By Appointment Date Time
E]Yes []go []Yes []No
APPLICATION FOR ASSISTANCE SOLICITUD DE ASISTENCIA
Applicant's Name(Last,First,Middle) Home TelephoneNo. Work Telephone No.
Nombre d.el Solicitante(Apellido,Nombres) Tel6fono-Casa Tel6fono-Trabajo
Mailing Address(Street P.O.Box,RFD) Apt.# city ZIP County State
Direcd6n Postal(Calle,Apdo.Postal o RFD) Apia.# Ciudad Condado Estado,
Home Address(if different from above)-It rural,give directions:/Direcci6n de Residencia(si es diferente de la de arriba)-Si es rural,explique o6mo flegar
Have you ever used another name?/L Ha usado aIguna vez otro nom bre? List other names you have used:/Escriba los otros nombres que ha usado:
E]Yes/Si [:]No If"Yes":/Si marca"Si":
Why are you asking for help now?ILPor qud necesita asistenda en este momento?
How did you meet your expenses until now?/jCon que dinero se ha estado sosteniendo?
1. Fill In line (a) about yourself. Fill in the remaining blanks for everyone who lives with you, whether or not you consider them
household members:
Llene el primer rengl6n con informaci6n sobre usted mismo. Llene otro rengl6n para cada persona de su casa incluyendo a las que viven
en su casa sin pertenecer a su caso de asistencia.
U.S. LEGAL IN
WHAT KIN DATE OF CITIZEN ALIEN SCHOOL SOCIAL SECURITY
NAME(Last,First,Middle) TO YOU? BIRTH SEX RACE CIUDADANO RESIDENTE ESTA EN LA NUMBER
NOMBRE(Apellido,Nombres) RELACION DE FECHA DE SEXO RAZA DE LOS EUA LEGAL ESCUELA NUMERO DE
PARENTESCO NACIMIENTO —— SEGURO SOCIAL
Si Si Sl
Yes No Yes' No Yes No
I
ApplicanVSolicitante SELF
(a) YO MISIVIO
(d)
(g)
[(h)
2. Do others live with you that you did not list above? YesIf"Yes,"how many?
lHay otras personas que viven con usted que no estdn en esta lista?. . F�❑Si No Si marca"Si,*Lcudntas?....
3. Is anyone in your household disabled? Yes No
jHay entre las personas de su caso alguna persona incapacitada?. . . . . . . . . . . . . . . . . . .
4. How much cash money do you and all those who live with you have(in pockets,bank accounts,anywhere else)?
Entre usted y todas las demds personas que viven con usted,IcuAnto dinero tienen a su disposici6n(en los
bolsillos,las cuentas bancarias,o donde sea)?- . . . . . . . . . . . . $
5. How many cars,trucks,or other vehicles does your household have?
LlCubtos carros,carniones,u otros vehiculos tienen las personas de su caso? . . . . . . . . . . . . . . . . .
1.Year/Ano Make and Model/Marcs y Modelo T,Year/Ano Make and Model/Marca y Modelo 3.YearJAno Make and Model/Marta y Modelo
6. Do you(or does anyone living with you)own or are you paying for a home,lot,land,life insurance,or other things?
0ene o est6 pagando Listed o a1guien que vive con usted una casa,un lote,un terreno!una p6liza de seguro de vida, Yes
0 al unci otra cosa?. . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Si FiNo
Form 1010
Page c
'
7. Did you or did anyone living with you sell,trade, �� b��m��? Y�
- ~' --^ -^ - ---� --= -- F-1 [-1
Dumntnkm6himmu8mosex.Ltraapeu6,vondi6umgal6uxtedoafguienqmovkveconuxteddinnmuoigunapmpiedad? . �_/S/ No
'
8. What is the total income(money,cash,or checks)that you expect your household bmreceive this month?
1CuAnto es el total de los ingnesos efectivonancheque)que esperan recibir en este mes entre
uxtedyVxaxlas domdxpersonas dexuCasa?. . . . . . . . . ... . . . . . ' ` ` ' ``
�
9. Do ���p� living with ���� �� �s
'~~ -`-- = -'"-- '-- ' ~—'' ' --~' [-� [-1
LRo�bnuw�doo�unopomwno4ue�vecon um�dd�emdaun�ub�oodean�enum�n�pa�un�ub�o? � F]Si L_|0o
'
10. anyone ��meu�"�n�um,orbo�? - +- Yes
~~`- `-- F]Si ZHay mn�000ua�unapemonuque�puguoboom�ao�nuoho?. . . . . �� L�Si L_JNo
11' ~~---"- in your household get uaoh`='- -- °~-'~~'~~~`~~~~~~ ~ ~^~'~' _ Yes
IRec�oa�unupemnnodo�nonad�em.�gabx p�m�mox noon�buo�naxdokmpodm�paden�o am�oxuo8nm?. - S(
F-1
No
12. Does anyone get any other h,or checks?
child support,unemployment,government checks,etc.)
�nemene�cUvupenchequex?(|nduyoconoos�neop��\uoscu�� Yes
^'-----=--'---~------'- [-7
bems.pr6�omos.mos1o�mie�npara nihoo.pugoxpordouemp(eo.cheques del gobierno.a�.) � . ���_/Si L_�Nu
13.List all of your household's income below:/D6 la siguiente informaci6n para todos Jos ingresos recibidos:
NAME OF PERSON WORKING NAME OF EMPLOYER,PERSON,OR HOW OFTEN AMOUNT IF SOCIAL SECURITY,
OR RECEIVING MONEY AGENCY THAT PROVIDES THE MONEY RECEIVED? RECEIVED ENTER CLAIM NO.
NOMBRE DE LA PERSONA QUE TRABAJA NOMBRE DEL PATRON,PERSONA.0 LCADA CUANTO CANTIOAD SI ES SEGURO SOCIAL
14. Have you orhas o living th�omon �� Yes
�`-- ' -- [-� F-1
Do�n�kmhNmom3meoeq ��h�6us�douhapesonaquev�acon us�d? . . `. �_�G� �_JNo
15. Have �m living �� ��8$da�? Yea
^--- -',--' - - ---- [-1 ��
Du�n�kwdhknno8Od�u Imnun�6aunkab�ouo�Uun�upemnnuquov�ncon un�d?� ��S1 �_�No
16. � �n �m�ho� ���� Yeo
- -`-- F-1 [-1
jEs�onhue�u�gunapemonede�uoou9 � , L�si F1 No
17. Living Arrangements/\,rivienda
Check all boxes that apply to your household:/Marque las casillas que se aplican a su caso:
Renting Own or Paying for Home Live with Relatives or Friends No Permanent Residence
Migrant or Seasonal Farmworker Does anyone else pay these expenses
Monthly Rent or Payment Monthly Utilities Telephone Tax on Home as, 11Sn-Surranc:10a nH me por usted?
18. Do you'-^ -^--to---
for ochild or other household member so that you can work or train for- '--' ` Yes
pm�pm���ab�a uo�dupampude mc��onkenum�o�.Zpagapo�que�uu�anua�dnn�u000�ndepnnd�o�?. R3i
L]
No
# � howmunhdu^ ^ per `'- `week,day)
Simarm 'Si,"Ioudntopaga? *
pm (mea oamana dia)
19.Are you or is �mU�m���m n�� �s U"��"wh*
._ �~~r-� [-� �� '
lEmamnban�udo�gunamu�rdeou�sa? �_�Gi L�No Bmon�"S[."Lquik?
20. Does have unpaid bU�fn�m�u���urm�u�w� Yew
-'^--' -' -- FISi�|'onp�g�emdexuoasacuon�om6d�um�nvagmrdo�odNmoxnuakomeaos? . � �_�Si �_�No
21'Does anyone have health insurance? Yes
1r*ne deuuoamomeQummddioo?. �� . � . [-�Si F-\No
22. Does anyone have monthly medical costs UbiUs,medicine,insurance,transportation,home*anA? Yes
F-1 �-1
�Tenoa�u�ndexuomagum�mmddk�mmenxudes�m,�emp�.uven�o.medkjnm.payood�moQumx.�anopo�un�n.c,Nudoenvuoo? L�Si �_/No
` .
,
THESE ARE THE BENEFITS THAT ARE OFFERED WITH THIS APPLICATION: Form 1010
CON ESl7\FORMA PUEDE DOUCR7glEQTOS8ENEFVC0S: Page
FOOD STAMPS—Helps you buy food for you and your family.
AFDC—bives you and your children cash assistance and helps with Medicaid.
MEDICAID—Helps you and your children with your medical expenses only.
:-AVANT TO APPLY FOR* Food Stamps Yes, AFDC �r,7 Y.e�I Medicaid i�. Y es,
S.
CHILD SUPPORT—Complete
NAME OF CHILD/NOMBRE DEL NI&O MOTHER'S NAMQN0MBRE DE LA MADRE FATHER'S NAMF4NOMBRE DEL PADRE
YOUR INTERVIEW SUENTR2NSTA
Every application must be followed byoninterview.Your Caseworker Cada solicitud requiere una entrevistaEnbentrevistuel
will mux you aboutand ask you to provide proof of the sohmoocaxo y pWopmuboxdebinbnoad6nqueostedhayadogo Sopuedenxo\icitar
Information you give. You can turn in one application for both AFDC emboubenoOcion.ontampi||uxpara oomidmyAFDC,con unosola nolicitud.
and Food Stamps.
PENALTIES SANCK}NES
FOOD STAMPS—Any member of your household who breaks the
ESTAMp|LUS PARA OOM|[A—Si u|guou persona de ou mmu viola una do las
following rules may not get food stamps for six months for the first uigoientem roQ|am, xu |a puede prohibiroxa persona recibir oxtampi||uu parauu�Wa
offense, 12months for the second oMenme, and permanently for the domme0me*s �phme��n�d6n. 12mmoex launda.yponnuoumomoNe
third offense; may befined upto$25V.0OUorjailed uptu2Vyears,nr mxla tencem; o*lepuede knponeunumukade *25O.000veinteahoxdnnjnm|. n
both;may bebuned.frnmthe Food Stamp program for anadditional 18 ambo» uancion*u| |oCorte puede pmhibirquemdbaextampi||uspara oomidadurunto
months |fordered bythe court; and may b* prosecuted under other ot/uu18mooeu;ypuede ser musaduante|uCorte bajootrauleyosfederales oextgo|es
state nrfederal laws: quosnupliquonaoucaso.Las mg{asson:
^ Don't make false urmisleading statements. orally mrinwriting, nr ^ No dor infonnmd6m fabo ni engaRosa, vorbalmente ni por omcrito, ni oxuondnr
hide information tnget benefits the household should not get. informaci6n,con el fin de obtener beneficios a los cuales las personas de su caso no
` Don't use food stamps to buy non-food items' such as o|nohn| or he»e»dare«h«'
cigarettes. ^ No uoa/ (e nutampi|bx para oomida para oomynar artkmbo—momo alcohol u
^ Don't change authorization cards (ATPs) mrother program aomeox oigarfi|los—qmanouoaocomestibles.
devices 10get benefits hwwhich the household|nnot entitled. ^ No okemr las tadetes de uutohzad6n (ATP),' torjetaa para entrega do bomefkciva
^ Don't use or have In your possession improperly obtained food o|eotrhoioumonte(EBT).niusaruknom6toduspara obtenorbena8dcsalos oualenlas
stamps,ATPn.orany other program access device. personas dosunaaunu\ienondarocho.
~ Don't trade or oaU food stamps, ATPm, or other program scoos» ^ No uoarnitoneren xu podereutampi||ao paca'cmmNa. ATP, herjetax de EBT ni nVn
device. mdtodoqophayanxWouNenidoui|egu|monte.
U a court of law finds you guilty of trading food stamp coupons for ^ No oamhiar nivender egampiUom para oomida.ATP, tarjehs do EBT ni oing6n oVn
firearms,ammunition,explosives or controlled mubx\anceu,you will be m6todnpara obtenerb000Udou.
subject\othe following penalties: SiunaCorte toha||acu|pub|ndeoambiaren|ampiUaupummomidapmannasd*bmgm`^ Loss of food,stamp benefits for twelve months for the first offense mooicionao, explo»km« o oogancias oontrdadax' uuted estoni ouieto u |oo uiguieote~and permanently /or the second offense involving the sale of a sondon*s:
controlled substance for coupons,and
~ Nnpuede recibir benelicioodueotampi~||~s para~~N~p~'d~°^~° p"' |aph
""`=~ Permanent loss offood stamp benefits for the first offense involving infmor6oyyo/manoo\nmmn\e por la»«gu»ua que nmgoquever con o/namomgeunu the trading offirearms,ammunition,orexplosives for coupons.
uusmnmuuooVnfadupnrostamp0uupara oumNa
AFDC—if you give wrong or misleading information, you could he ^ ponnanoo�me�epm�phmem�huoddoqoe—y
aqmowar000e{oumb�daanmao
pro ppcutpd' and bosentenced for upto1Uyears inprison.You could du�ogo mun�uoeooexp�uiwmpmon�m�||=m�`nomida
bouukpdtorepay hene�to hoveywurcheckpaduued or ' =^p=~
from eo��|n AFDC � ' disqualified, ' �� i e AF[K�'Siu�*ddoi��n»adh» �|»un enyahooa puedbn auusadoan� |ocon� y(o
g you amyou may n moav ' '
'—� �---' AFDC. '' ~ ~` receive oun��n para e{ culpable puede ser h��o 1O ohnx en b odom| Le pod(r'uo
AFDCondMed�a��nsbnmn�shx�e5eto#ono� 12mnnthufor ' »
Uevue
�hemecondw�enue'mn�pe�monenUyfurthethird offense. hakmbehe8d»«. �puedoned��asbo �pundemUe»mUN�ryum
MEDICAID—It ynugivu wrong or m(s(e~d(ng (ohzr-a��on or |et AFDC.LmP*mu«aV«o»odow»a|ifkmdanopu�emdbkAFDC yModk��du�M�so�
''' moaeo po/|ophmeroinhouddn 12 moxen pur\uxogundu y pennono�eme�epm \a
someone else use your Medical Care|dentihnohunForm,you could be te�em ' '
/pqu|mdtopay back the o��orfederal govemmentfor any benefits �
issued inoonecUymb�prooeoutud. MEDICAID—Si ua�d da��nnad6n�bx u un0a�ae o d�a qua�no persona use su
/demhficad6wpara ServicioxM6dkcom.lepuedenpedkqo*pugooatoutadooa]yobiamo
federal uualquierouohdud de bonofidnx qua haya mcibido sin toner do/echo a e(bs' o
puedon.aouoadoante bCorte.
Form 1010/Page 4
CERTIFICATION CERTIFICACION
My signature below indicates that I understand and agree to the Mi firma abajo indica que comprendo y estoy de acuerdo con to siguiente:
following: Si aprueban mi solicitud de AFDC, la cantidad que reciba podra dar Lugar a una
If approved for AFDC,the amount I receive could cause'my food stamp reducci6n o una negaci6n de mis beneficios de estampilias para comida. Tambidn
benefits to end or be lowered.i understand that if this happens,I wiil not. comprendo que si sucede esto,no voy a recibir ning6n aviso anticipado del camblo en
receive advance notice of the change to my food stamp benefits. mis beneficios de estampillas para comida.
if approved for Medicaid services,I authorize each provider of Medicaid Si aprueban mi solicitud para servicios de Medicaid, autorizo a sada proveedor de
services to me or my family to release any medical or other information servicios de Medicaid para mi o mi familia para que les comunique cualquier
necessary for the provider to be paid by Medicaid. informaci6n medica o de otro tipo que sea neoesaga para que Medicaid pague at
That information on work is available from the Texas Employment proveedor'
Commission (TEC). Members of my household may be required to Que en la Comisi6n de Empleos de Texas (TEC) hay informaci6n sobre empleos.
register for work,be Interviewed,look for work,and accept suitable work Ciertos miembros de mi casa pueden registrarse para trabajar, tener una entrevista,
if offered. buscar trabajo,y aceptar cualquier oferta de trabajo apropiada que reciban.
It I am not satisfied with the decision on my application,I may request a Si no estoy satisfecho con la decisi6n sobre mi solicitud, puedo apelada y pedir una
hearing In writing or orally within 90 days of the date f am notified of the audiencia por escrito o verbalmente en un plazo de 90 dias contados desde is fecha
decision.i may also file a complaint with the civil rights officer if 1 feel I del aviso de la decisi6n. Tambidn puedo presentar una queja ante el director de
have been discriminated against because of race,color,religion,national derechos civiles si cxeo que me han discriminado por motivo de color, raza, religi6n,
origin,age,sex,disabling condition,or political belief, origen nacionai,edad,sexo,incapacidad o creencia politica.
That DHS and state or federal agencies will verify any information that Que el Departamento de Servicios Humanos y otras agencias federales o estatales
affects my eligibility. My signature below authorizes release of such verificaran toda la informaci6n que tenga que ver con mi elegibilidad.Las agencias que
Information to the Department of Human Services. tengan tai informaci6n la pueden poner a la disposiici6n del Departamento de Servicios
i certify under penalty of perjury that the Information I have provided on Humanos.
this application Is true and complete to the best of my knowledge. Certifico bajo juramento que la informac16n que doy en esta solicitud es verdadera y
completa a mi teal saber y entender,
Signature/Firma Date/Fecha Signature-Authorized Representative Date/Fecha
Firma-Representante Autorizado
Signature-Spouse/Firma-Esposa(o) Date/Fecha
If you want someone besides the head of your household, Si quiere que aiguien que no sea la cabeza de la Casa, ni su esposa(o),
your spouse,or a responsible household member to apply for ni otro adulto responsable de la Casa le haga la solicitud de beneficios,
benefits for you, give his or her .name and address. This d6 el nombre y la direcci6n de esa persona. Esa persona Bebe firmar
person must sign on the"Authorized Representative"line. sabre"Representante Autorizado"
Name/NombreTei ephonerreldtono
Address(Street,City,State,ZIP)/Direcci6n(Calle,Ciudad,Estado,ZIP)
If you want someone besides the head of your household or your Si desea autorizar a aiguien que no sea ni la cabeza de la Casa ni su
spouse to receive and use benefits for you,give his or her name esposa para recibir los beneficios de usted y usarlos para usted, de el
and address: nombre y la direcci6n de esa persona:
Name/Nombre Tet ephone/Teldfono
Address(Street,City,State,ZIP)/Direcci6n(Calle,Ciudad,Estado,ZIP)
If someone helped to complete this form, please give his or Si aiguna persona le ayud6 a Ilenar esta solicitud, por favor, d6 el
her name and address below, nombre y la direcei6n de esa persona:
Name/Nombre TeiephanejTel6fono
Address(Street,City,State,ZIP)/Direcei6n(Calle,Ciudad,Estado,ZIP)
FOR AGENCY USE ONLY Qualified Provider Application Date Date Approved
PARA USO DE LA AGENCIA
TEXAS DEPARTMENT OF HUMAN SERVICES DEPARTAMENTO DE SERVICIOS'HUMANOS • 10
APPLICATION FOR ASSISTANCE SOLICITUD DE ASISTENCIA
Several programs are available to help you meet food, money, Hay vados programas que pueden ayudar a satisfacer las necesidades de comida,
and medical needs. Before you receive help, you must meet dinero, y atencift m6dica. Para obtener esta ayuda, hay ciertos requisitos. La
requirements. Eligibility depends on Income, resources, and elegibilidad depende de los ingresos,los recursos,y otras cosas por el estilo.
other Items. PROGRAMA DE ESTAMP* ILLAS PARA COMIDA-Este programa ayuda a las
FOOD STAMP PROGRAM-This program helps low-income casas que tienen baqos ingresos a comprar la comida necesada para mantener la
households -buy food needed for good health... Eligible salud. Las casas elegibles reciben sus beneficios,de estampillas para comida en
households receive food stamp benefits within 30 days.Texas un plazo de 30 dias.El estado de Texas entrega las beneficios dt.",stampillas para
provides food stamp benefits within one day If: comida en un dia si:
• your household's countable gross Income Is less than $150 en el mes de la solicitud, los ingresos netos contables de las personas de su
and combined liquid resources do not exceed $100 for the caso son menos.de$150 y el valor dela combik rso
ac!6n de sus recu s liquidos
month of application; es menos de$100;
• your household's countable.resources and gross monthly - el total de los recursos, contables y los ingresos netos mensuales de las
Income total less than your most recent monthly rent, or personas de su caso es menos que el gasto mensual mos reciente de rents o
mortgage,and utilities expenses; abono de la casa y servicios de gas,luz y agua;
• all members In your household are homeless Individuals;or - ninguna de las personas de su caso gene casa donde vivir,o
your household Includes destitute migrant or seasonal farm - entre las personas de su caso hay indigentes que son trabajadores migratorios
workers. o de temporada.
"Household" usually means the.people who live and eat Las pers onas de'un case generalmente son un grupo de personas que viven y
together. If someone Is over 60 or disabled, different rules may comen juntas. Si aiguna de las personas del caso es mayor de 60 ahos o es
apply.
incapacitada,las reglas pueden ser diferentes.
If you are eligible, benefits are determined from the date you Los beneficios para las personas,elegibles corren desde el dia que se erift"a la
turn In your application. You can ask someone else to fill out solicitud.Cualquier persona puede Ilenar la solicitud de beneficios de estampillas
the form to apply for food stamp benefits for your household., para comida para el grupo.
If you are a resident of a public Institution and you plan to apply Para la persona que vive en una insfituci6n p6blica y que piensa solicitar
for food stamp benefits through - the Social Security beneficios de estampillas pare comida a trav6s de la Administraci6n del Seguro
Administration (SSA), your application file date Is the date of Social(SSA),la fecha de entrega de la solicitud es la fecha que le den de alta de
your release. If you are an applicant or recipient of [a instituci6n. La persona que solicita o recibe Seguddad de Ingreso Suplemental
Supplemental Security Income (SSI), you may file your (SSI) puede entregar su solicitud a SSA y sus beneficios correrin desde la fecha
application through SSA.Your file date Is the date SSA receives que SSA la recibe.
the application.
AFDC (Asistencia a Familias con Nifios Dependientes)-Las casas elegibles que
AFDC (Aid to Families with Dependent Children)-Families with tienen nihos pueden recibir dinero en efectivo, y asistencia m6dica. Para ser
children can get cash and medical help.To be eligible,at least elegible,el padre o la madre--por to menos,uno de ellos—tiene que estar ausente
one parent must be out of the home, disabled, not legally del hogar, incapacitado, no tener ningOn parentesco legal con el nifio o no tener
related to the child, or unemployed. If you are eligible,you will empleo. Las casas elegibles recibirdn sus primeros beneficios dentro de un plazo
receive your first benefit within 45 days. You will also receive de 45 dfas.Tambidn recibirin Medicaid.
Medicaid.
MEDICAID-Medicaid puede ayudar a pagan cuentas m6dicas de un nifio o de una
MEDICAID-Medicaid may help pay for medical bills of a child or muier embarazada s►se deben cuentas m6dicas—o se esperan cuentas--que las
pregnant woman It the medical bills have not been paid,or If the personas del caso no pueden pagan.Tambidn es posible que Jos miembros de la
household expects medical bills that the household won't be familia que no son elegibles para AFDC o que no la quieren tambi6n sean
able to pay. Family members who are not eligible for or do not cubiertos por Medicaid. Medicaid puede cubdr cuentas m6dicas hasta de Cres
want AFDC may also be covered. Medicaid coverage can begin meses antes del mes que se entrega la solicitud.
as early as three months before the month you turn In your NOTA:Para recibir informaci6n sobre Medicaid para los miembros de la casa de
application. edad avanzada o adultos incapacitados, p6ngase en contacto con los Semcios
NOTE: For Medical Assistance for elderly or disabled para Personas de Edad y Adultos Incapacitados del Departamento de Servicios
household members,contact DHS'Aged and Disabled Services Humanos de Texas.
for Information about Medicaid.
Try to fill out as much of the form as possible.NOTE:If you want to Trate de contestar todas las preguntas, NOTA: Si quiere solicitar solamente
apply only for Medicaid for families and children(and not AFDC or Medicaid para familial y nihos (y no AFDC P beneficios de estampillas para
food stamp benefits),you do not have to answer questions 5,9,17, comida), no tiene que contestar las preguntas 5, 9, 17, 18 o 25. Entregue su
18,or 25.Turn In your application today even If you cannot answer solicitud hoy, aun si no puede contestar algunas de las preguntas. Se puede
all the questions.You may turn In your application with your name, entregar to solicitud con solo el nombre, [a direcci6n y la firma del solicitante.
address and 'signature only. If you are eligible, benefits will be LOS BENEFICIOS PARA LAS PERSONAS ELEGIBLES CORREN DESDE EL
determined from the date you turn In your application. YOUR DIA QUE SE RECIBE LA SOLICITUD EN LA OFICINA APROPIADA DEL
APPLICATION IS NOT FILED UNTIL IT IS RECEIVED IN THE DEPARTAMENTO DE SERVICIOS HUMANOS (DHS), 0 EN OTRO LUGAR
CORRECT TEXAS DEPARTMENT OF HUMAN SERVICES OFFICE DESIGNADO. Si tiene problema para comunicarse con la oficina apropiada, un
(DHS), OR IS RECEIVED BY DHS IN OTHER DESIGNATED empleado de DHS le puede ayudar a entregar alli su solicitud.
LOCATIONS. If you have difficulty contacting the correct office, a
DHS staff member will assist you In getting your application to the
correct office.
X
Name Qa3t,fir3t)/Nombre(apelfido,nombre) Signature-Applicant/Representative DatejFTdza—
Firma—Solicitante/Representante
Address-Street/Direcei6n-Calle Apt4Apartameriwo City/Ciudad State/Estado ZIP
Form 1010 Instructions/4-96
RESPONSIBILITIES RESPONSABIUDADES
..Yo u may be asked to provide proof of what you write on your Pueden pedicle pruebas de cualquier informaci6n que de por escrito en
".application.or tell your worker. If you need help getting proof, la solicitud o que.diga al trabajador. Si necesita ayuda para encontrar
your worker will help. las pruebas,su trabajador tratara de ayudarle.
ALL PROGRAMS—You will be asked to prove.where you live TODOS LOS PROGRAMAS—Le van a pedir pruebas de su direcci6n y
and.the-amount of.Income you get. You maybe asked to de Jos ingresos que tiene.Si es necesario para su caso,Ie pueden pedir
provide other information,such as the amount of your bills,If It otra .aformaci6n sobre, por ejemplo, las cuentas que debe. Como prue-
makes a difference In your,case. Paycheck stubs, bills, bank bas, puede usar, por ejemplo, talones de cheques de paga, cuentas,
statements, legal papers or statements by people outside the,. balances del banco, documentos legates,o declaraciones de otras per-
household can usually be used for proof.You must provide the sonas que no que m'sembros de la casa. Debe dar el numero de
social security number for each person in your household. Seguro Social de sada miembro dela Casa.N-
FOOD STAMPS--You will also be asked to prove who you are. ESTAMPILLAS PARA COMIDA--Le'van a pedir ademas que ensefie
` alguna identificaci6n."
AFDC—You will be asked to prove that the,children live in your
home,how they are related to you,and their age.If the children AFDC . Le van a pedir pruebas de que los ninos viven en la casa de
.far whom you are applying are deprived"of parental support usted, de la relaci6n entre usted y Jos ninos,y de la edad de los ninos.
due to the absence of a'parent,you will be required to help find Si a los ninos nombrados en la solicitud les falta el sostenimiento de
the absent parent or establish who the legal parent Is unless uno de los padres debido a su ausencia, le van a pedir que ayude a
you have goad reason not to.You must agree to let DHS keep encontrar,al padre ausente o a establecer'la patemidad legal a menos
any child support paid while you get AFDC.You will be asked que tenga usted motivo justificado para no Icooperar. Usted debe
to provide verification that your'child(ren) who are under six aceptar, mientras este recibiendo AFDC, que DHS se quede con cual-
years old are Immunized. quier dinero de sostenimiento que pague el padre del nino.
MEDICAID AND AFDC--You will be asked to give Information MEDICAID Y AFDC—Le van a pedir informaci6n sobre cualquier otro
about any other medical insurance members of your household seguro de salud que tengan los miembros de su casa. Usted debe
may have. You must agree to let DHS .keep any medical aceptar, mientras reciba Medicaid, que QHS se quede con cualesquier
payments made by others while you receive Medicaid... pagos hechos por otros seguros de salud. .
Social Security numbers(SSNs)are used to collect Information Las numeros de Seguro Social(SSN)se usan para obtener informaci6n
from sources. other than DHS, to check the Identity of de otras agencias fuera de DHS para averiguar la identidad de los
household members,to prevent households from getting more miembros de la Casa, para evitar que las casas reciban mos beneficios
benefits than they should,and to identify groups of cases that de las que deben recibir, y para identificar grupos de casos que
must be changed.We use SSNs to make sure your household requieran cambios. Tambien usamos los .numeros de Seguro Social
Is eligible.Ve do.this through program reviews, audits, or, para saber si la casa es elegible. Esto to hacemos a traves de revisio-
computer:.matching with other :agencies ;such :as . Texas. nes de los programas,auditorias,o comparaci6n por computadoras con
Employment Commission, Social Security. Administration, and los archivos de otras agencias como la Comisl6n de Empleos de Texas,
internal Revenue Service.Your alien status may be verified by la Administraci6n del Seguro Social, o ,el Servicio de Impuestos
immigration and Naturalization Service (INS). This information Federales. EI Servicio de Inmigraci6n y Nacionalizaci6n (INS) puede
may change your eligibility or benefits. verificar su caudad de inmigrante. Esta informaci6n podria cambiar su
elegibilidad para beneficios.
After you finish your application, you are required to report Despues de entregar la solicitud, usted debe informar, dentro de un
changes within 10 days. Report changes in your address, in- plazo de 10 Bias, de cualquier cambio de direcci6n, ingresos, gastos,
come, expenses, resources, people living with you, or other recursos, personas que viven con usted, u otro aspecto de su vida que
changes that could affect your case. podria afectar su caso.
Information on race and sex Is voluntary. It Is used to make La informaci6n sobre raza y sexo es voluntaria. Se usa s6lo para
sure that benefits are provided without regard to race, color, asegurar que el cliente reciba beneficios sin discriminaci6n de raza,
or national origin. it will not affect your eligibility or benefit color, ni origen nacional. No afectarA su elegibilidad ni la cantidad de
level. sus beneficios.
CONFIDENTIALITY CONFIDENCIALIDAD
DHS considers that Information is confidential if It is used EI departamento considera confidencial la informaci6n que se use
to determine a client's eligibility for services. DHS para determinar la elegibilidad del cliente para senticios. Esta
considers the Information confidential whether collected informaci6n la oonsidera confidencial cuando es recogida por el
by DHS,staff or contracted provider staff. personal del departamento y tambi6n cuando es recogida por el
personal de proveedores contratados por el departamento.
Form 1010 Instructions,Page 2
v
ATTACHMENT B: BACK-OF-THE-AFDC-CHECK STATMENT
rvdraft.doc, 7/2/96, P.17 17
C.10
FRONT OF WELFARE CHECK
------------------------------------------------------------------------------------------------------------
Please Detach Here
STOP
DO NOT SIGN YOUR NAME ON THE BACK OF THE ATTACHED CHECK UNTIL YOU HAVE READ THIS PAGE.
The questions below apply to everyone receiving Cash Aid(the children's parents,stepparents and your spouse if in the home).
• Did anyone get money from a job or a training prograin in the last month?(including tips,vacation pay or income in
kind such as hOnSing,utilities and/or food in exchange for work)
• Did anyone receive money or benefits from any other source in the last month?(such as Social Security,Railroad
Retirement,Unemployment/Disability Benefits,Veterans Benefits,Interest from Stocks,Bonds,Savings Accounts,
Worker's Compensation,SSI/SSP,Child/Spousal Support,Child Support Disregard,Loans,Grants,Scholarships,Strike
Benefits,Tax Refund,Cash,Lottery Winnings,Gifts,Rental Income,Free Housing,Utilities,Food,Clothing,or cash
from an Insurance Policy,Insurance or Legal Settlement,etc.)
• Did anyone move into or out of your home or did you move in with someone else in the last month?(including
anyone who died and/or any newborns)
• Does anyone have anything else to report that occurred in the last month?(including unexpected changes)
If the answers to any of these questions is"YES"and you have not reported these changes to your Eligibility Worker,you may not
be entitled to the full amount of the attached check or you may be eligible to receive more benefits. Please contact your
Eligibility Worker before signing the back of the check to avoid any possible penalties. Failing to report information or
misrepresenting facts for Cash Aid programs,Food Stamps or Cash-based Medi-Cal can result in legal prosecution with penalties
ofa fine,imprisonment or both. In the Food Stamp and Cash Aid Programs the penalties can result in permanent disqualification
from the Program. Disqualification penalties for Intentional Program Violations(IPV)are six months for the first violation, 12
months for the second violation and permanent disqualification for the third violation. In addition to disqualification for IPV,
other penalties can result in fines and/or imprisonment.
If the answers to all of these questions are"NO"or if you have reported the changes to your Eligibility Worker,please sign the
attached check.
If you do not read English or Spanish,please call your Eligibility Worker to arrange for translation before signing the
attached check.
[ABOVE STATEMENT IN VIETNAMESE]
(ABOVE STATEMENT IN
[ABOVE STATEMENT IN M EON]]
[ABOVE STATEMENT IN HMONG]
[ABOVE STATEMENT IN MANDARIN]
[ABOVE STATEMENT IN CANTONESE]
[ABOVE STATEMENT IN HINDUSTANDI]
[ABOVE STATEMENT IN GUJARIT]
[ABOVE STATEMENT IN FRENCH]
Y•' .c p
y Z°
� O} Gs•• d K y... .
a m z r w pq;
t a
u
3 c k ca a �s
a c
a
v oz
z�v
`d w-c
Z0
y
�avduao x'w��
H `d G2E� d 'E SE'
c m W
.L'
EEEu'oaE
iC
W C C d g V A= g W«m
E
U C =
aEam �Nva� -
I E :' d�.c a._ ccwa''
Via» d
� cu.cC`o9C7 $c�au
19 yoN7E3d d Z°cam
'o" a.m� EZ Oaaa
u,mco Emot1 Iz
------------- -----------------------------------------------------------------------------------------------
Please Detach Here
[THIS PAGE IN SPANISH] S TOP
DO NOT SIGN YOUR NAME ON THE BACK OF THE ATTACHED CHECK UNTIL YOU HAVE READ THIS PAGE.
The back of the attached check says the following:
"By signing my name below,I hereby state that either(1)no changes have occurred in my circumstances that affect the
amount of this check OR(2)1 have met my responsibilities to report to the County my earned income and/or any changes
in my circumstances that could affect the amount of this check. I certify under penalty of perjury under the laws of the
State of California that the foregoing is true and correct.
Payee Sign Here:..DO NOT.SIGN HERE SIGN ON THE BACK OF TILE ATTACHED CHECK]
NOTE: ENDORSEMENT MUST BE AFFIXED IN THE PRESENCE OF THE PERSON CASHING THE CHECK.
This check most be endorsed in ink or indelible pencil on the line above by the person in whose favor it is drawn and the
name must be spelled exactly the same as it is on the face of the check."
The questions below apply to everyone receiving Cash Aid(the children's parents,stepparents and your spouse if in the home).
• Did anyone get money from a job or a training program in the last month?(including tips,vacation pay or income in
kind such as housing,utilities and/or food in exchange for work)
• Did anyone receive money or benefits from any other source in the last month?(such as Social Security,Railroad
Retirement,Unemployment/Disability Benefits,Veterans Benefits,Interest from Stocks,Bonds,Savings Accounts,
Worker's Compensation,SSI/SSP,Child/Spousal Support,Child Support Disregard,Loans,Grants,Scholarships,Strike
Benefits,Tax Refund,Cash,Lottery Winnings,Gifts,Rental Income,Free Housing,Utilities,Food,Clothing,or cash
from an Insurance Policy,Insurance or Legal Settlement,etc.)
• Did anyone move into or out of your home or did you move in with someone else in the last month?(including
anyone who died and/or any newborns)
• Does anyone have anything else to report that occurred in the last month?(including unexpected changes)
If the answers to any of these questions is"YES"and you have not reported these changes to your Eligibility Worker,you may not
be entitled to the full amount of the attached check or you may be eligible to receive more benefits. Please contact your Eligibility
Worker before signing the back of the check to avoid any possible penalties. Failing to report information or misrepresenting facts
for Cash Aid programs,Food Stamps or Cash-based Medi-Cal can result in legal prosecution with penalties of a tine,
imprisomnent or both. In the Food Stamp and Cash Aid Programs the penalties can result in permanent disqualification from the
Program. Disqualification penalties for Intentional Program Violations(IPV)are six months for the first violation, 12 months for
the second violation and permanent disqualification for the third violation. In addition to disqualification for IPV,other penalties
can result in fines and/or imprisonment.
If the answers to all of these questions are"NO"or if you have reported the changes to your IEligibility Worker,please sign the
attached check.
If you do not read English or Spanish,please call your Eligibility Worker to arrange for translation before signing the
attached check.
[ABOVE STATEMENT IN VIETNAMESE] r
[ABOVE STATEMENT IN LAO]
[ABOVE STATEMENT IN MIEN]
[ABOVE STATEMENT IN HMONG]
[ABOVE STATEMENT IN MANDARIN]
[ABOVE STATEMENT IN CANTONESE]
[ABOVE STATEMENT IN HINDUSTANDI]
[ABOVE STATEMENT IN GUJARIT]