(COUNTY DEPARTMENT OF HUMAN SERVICES LETTERHEAD)
In this packet of material you will find an application for public assistance. You will need to complete, sign and date this application and return it to the county department of human services as soon as possible. The county department of human services must inform you of the decision reached on your application within 45 days of the date you file a signed and dated application.
You may submit your application at any time in person or by mail. The date of application is the date on which a signed and dated application form is received by the CDHS.
It is important that you read this letter and the enclosed material thoroughly so that you will know what to bring with you when you come for the interview and how the application will be processed.
THINGS YOU MUST DO:
You must truthfully complete the application and sign and date it. If you need help in completing the application form, you may have a friend or relative help you. If someone helps you, there is a place for the person to sign the form as someone who helped you. Do not pay someone to help you. If there is no one you want to ask to help fill out the application, please ask for help at the county department of human services. Someone there will help you.
You must come to the scheduled interview to discuss your application with a caseworker. You must tell the county department as soon as possible if you cannot come to the interview at the date and time you are scheduled. Your interview can be rescheduled if necessary. If you cannot come at the time scheduled or you are late for the interview, your assistance may be delayed or denied. Each adult member 18 years of age or older applying for assistance should come to the scheduled interview, if possible.
NOTE: You are not required to come to the county department of human services for an interview if you are applying for Healthy Start/Expedited Medicaid only. You can complete the application process by mail.
You must provide proof of the statements made on your application form and/or in your CRIS-E interactive interview. Things you must bring to prove your statements are listed on the ODHS 7104 "Application/Reapplication Verification Request" enclosed with this packet. The county department of human services will be unable to determine your eligibility for assistance without the required verifications.
You must report any changes (e.g., move, get a job, have a baby) in your situation within ten calendar days to the county department of human services.
WAYS YOU CAN HELP THE COUNTY DEPARTMENT OF HUMAN SERVICES MAKE A PROMPT DECISION ON YOUR APPLICATION:
You can ask questions when you do not understand something.
You can tell the county department of human services if you need help in completing the application form or completing the interactive interview.
You can tell the county department of human services when you are having trouble getting any verifications requested.
You can keep your appointments with the county department of human services and show up on time.
You can try to make arrangements for the proper supervision of your children during your appointments with the county department of human services. If you cannot leave your children with a babysitter or relative, please try to bring someone with you who can watch your children while you are meeting with your caseworker.
YOU HAVE A RIGHT TO:
Ask questions about any part of your case.
Have a state hearing if you think something is wrong with any part of your case.
Have any information you give the county department of human services kept confidential.
See the manuals used to determine your eligibility.
Review your assistance group record or those CRIS-E screens showing the information you provided and the CRIS-E screens showing the results.
Have a prompt decision on your application.
Receive a written notice explaining the type and amount of assistance you are eligible to receive.
Reapply for assistance at any time.
If you have any questions about the completion of this application, please contact the county department of human services.