Official revised 06/19
(1) SOCIAL SECURITY NUMBER(SSN):
Pursuant to 42 USC 1320b-7, the SSNs
of
persons applying for and receiving help
in
the Financial
and
SNAP will be used to check identities of household
members prevent duplicate participation, verify income/asset amounts
and
to do mass changes. SSNs will also be used
in
program reviews or audits
and
in
computer matching with the Internal Revenue Service, State Department
of
Labor, and Social Security Administration to make sure your household
is
eligible. This
may result
in
criminal or civil action
of
administrative claims against persons fraudulently participating
in
the Financial Program and SNAP.
(2) YOU HAVE THE RIGHT:
To discuss any action
regarding your case with your worker or the supervisor
if
you are dissatisfied.
To be notified
in
advance before your benefits are reduced or discontinued.
To ask for a hearing in writing, or orally for SNAP,
if
you are dissatisfied with any action by the
OHS,
and to ask the Legal Aid Society
of
Hawaii, or anyone you want, to help get a hearing. Your case may be presented at the hearing by any person you choose.
To have your record kept confidential.
To have a bilingual or sign-language interpreter.
All our oral
and
written communication to you will be
in
English. If you do not understand what
you hear or read, please contact your worker right away.
In
accordance with Federal law and U.S. Department
of
Agriculture (USDA)
and
U.S. Department of Health and Human Services (HHS) policy, this
institution
is
prohibited from discriminating
on
the basis
of
race, color, national origin, sex, age, or disability. Under the Food and Nutrition Act and USDA
policy, discrimination
is
prohibited also
on
the basis of religion or political beliefs. To file a complaint
of
discrimination with the Department, contact the Civil
Rights Compliance office at 1390 Miller Street Room 214, or call (808) 586-4955, or contact USDA or HHS Write USDA, Director, Office
of
Civil Rights, Room
326-W, Whitten Building, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410 or call (202) 720-5964 (voice and TDD). Write HHS, Director,
Office for Civil Rights,
Room
506-F, 200 Independence Avenue, SW., Washington, D.C.
20201
or call (202) 614-0403 (voice) or (202) 619-3257 (TDD). USDA
and HHS are equal opportunity providers and employers.
(3) YOUR RESPONSIBILITIES:
All households (Simplified and Change Reporting) must apply for and accept all potential sources
of
income and assets. Failure to do so may
result in benefits stopping and ineligibility.
SIMPLIFIED REPORTING HOUSEHOLDS
If your household
is
determined to
be
a Simplified Reporting household you are required to complete a Six Month Report form. You are only required to report the
following items on your Six Month Report: any change
in
residence; new employment; earned income verification and self-employment expenses
all
other sources
of
income; changes
in
household composition; and any changes
in
resources. For the SNAP, you must also report a change
in
shelter cost
if
you have moved and
any changes in legal obligation to pay child support.
In
addition to the Six Month Report, you will have to report the following within
10
days
of
the change for the financial assistance programs: any change
in
household composition and when the household's total gross income exceeds 100%
of
the Federal Poverty Limit (FPL). For the SNAP, you are required to report
when the household's total gross income exceeds 130%
of
the FPL. For SNAP households that include a member who
is
considered an able-bodied adult without
dependents (ABAWD), you must report when work or training hours decrease below 20 hours a week or termination
of
employment or training. Households
receiving assistance from more than one program shall report the changes
as
required for each program. Changes may be reported
in
writing,
in
person or by
telephone.
REPORTING CHANGES FOR ALL OTHER HOUSEHOLDS
Households who are not simplified reporting households shall
be
required to report the following changes within ten days
of
the date the change
becomes known; or
if
the change involves income, the change must be reported within ten days of the date that the first payment
is
received.
Unearned Income: A change
in
the source
of
unearned income
and
a change
of
more than $50
in
the amount
of
unearned income, except changes
related to the financial assistance grant. Examples
of
unearned income: Supplemental Security Income (SSI); Unemployment Compensation (UIB);
Veteran's Benefits (VA); Tax Refunds; Insurance Settlements; Inheritance, gifts or contributions from relatives; dividends pensions, retirement or
Social Security benefits, child support
and
alimony, etc.
Earned Income: All changes
in
earned income, including starting, stopping or changing a job. Receipt
of
irregular earned income, for example,
commissions, lumpsum payments, etc.
Household Composition: All changes
in
household composition, such
as
the addition or loss
of
a household member.
Assets: When cash on hand, stocks, bonds, and money
in
a bank account or savings institution reaches or exceeds the program's asset limit.
Changes
in
Residence and Shelter Costs: A change
in
residence, and for the SNAP the resulting change
in
shelter costs.
Child Support Obligations: For the SNAP, any change
in
legal obligation to pay child support.
ELECTRONIC BENEFITS TRANSFER (EBT)
You
are responsible to report lost, stolen, or misused EBT CARDS immediately by calling the EBT toll-free customer
service number, or by accessing the EBT website at www.ebtEDGE.com. There will
be
no replacement of any benefits accessed with
an
EBT card prior to the card
being reported lost, stolen or misused. You are responsible to report immediately any changes
in
the status
of
your alternate payee. There will
be
no
replacement
of
any benefits accessed by alternate payees or any other individuals using
an
EBT card and a valid
PIN.
Benefits not withdrawn for 112 days for cash assistance
accounts and for 365 days for SNAP accounts will
be
returned to the state.
(4) PENAL
TY
WARNING:
Do not make any false statements or hide any information.
Sanctions and court prosecution may be pursued under applicable state and federal laws.
Do
not
do
anything
dishonest
to
get
money
and SNAP benefits
which
you
are
not
supposed
to
get.
Do
not
give, trade
or
sell
your
SNAP benefits
or
EBT card
to
anyone else.
Do
not
alter
or
use someone
else's
SNAP
or
EBT card
for
your
household.
Do
not
use
your
SNAP benefits
or
EBT card
to
buy
ineligible items
such
as
alcoholic
drinks
and tobacco.
For
the financial assistance program, an intentional
program
violation
disqualification penalty
is
twelve
months
for
the
first
violation,
twenty-four
months
for
the
second
violation
and permanently
for
the
third
or
more violations.
For
the
SNAP,
any
household
or
family
member
who
intentionally
breaks SNAP rules, can be fined
up
to
$250,000, imprisoned up
to
20 years
or
both. A
member
of
your
household
can be barred
from
SNAP
for
one year
for
the
first
violation;
two
years
for
a
second
violation and permanently
for
the
third
or
any
subsequent
violation
and an additional 18
months
if
court
ordered. The individual
may
also be
subject
to
further
prosecution
under
other
applicable Federal laws. A member convicted
of
using
or
receiving SNAP benefits
in
a transaction
involving
the sale
of
firearms,
ammunition
or
explosives
is
permanently ineligible
to
participate in SNAP. Individuals convicted
of
trafficking
SNAP benefits
of
$500
or
more are
permanently ineligible.
Individuals
found
guilty
to
have used
or
received SNAP benefits in a transaction
involving
the sale
of
controlled substance are ineligible
to
participate
for
two
years
for
first
violation
and permanently
for
the second violation. Individuals
who
have committed and been convicted
of
Federal
or
State felonies
after
8/22/96
for
possession, use
or
distribution
of
illegal
drugs
and
who
refused
to
comply
with
treatment
or
with
a treatment
program
are ineligible
for
the program.
An
individual
is
ineligible
to
participate
in
the financial and SNAP
for
10 years
if
found
to
have filed more
than one application
at
the
same
time
and have given false identification
or
residence information. Fleeing
felons
and probation/parole
violators
are
ineligible
for
the
financial and SNAP.
OHS
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(6/19)
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