EA Forms

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Across
  1. 1. AD, Proposed Additional Adult Household Member Approval Denial Form
  2. 5. Request, This form is used to record and request an EA applicant's need for TransAction Associates' transportation services
  3. 10. Assistance Notice for Important Documents, The multi-lingual form that states that this is an important document and the number to call to receive assistance. It can be attached to documents that are not currently translated in the applicant’s preferred language.
  4. 11. Verification Checklist, The checklist of outstanding required verification documents needed to determine an applicant's EA eligibility.
  5. 12. The form used to add an Extra Adult Relative to the EA family
  6. 13. Application, the form an applicant completes to start the EA eligibility process for shelter services
  7. 14. (Proposed Additional Adult Household Member Form) - The form to request to add a proposed additional adult household member to the household receiving EA Temporary Emergency Shelter Benefits.
  8. 16. Six Month Notice, A notice is to inform EA participants their family’s income monthly gross exceeds the EA Eligibility Standard for a family of their size and their shelter benefits are scheduled to end in six month. They have 21 days to appeal.
  9. 18. – Approval and Denial, The form that documents final EA eligibility
Down
  1. 2. Service Animal, A service animal is a trained and certified dog that may be paired with a person with a disability to help their owner function on a daily basis, including completing tasks and alerting them to potential oncoming emotional or physical episodes.
  2. 3. Assessment Referral, Health and Safety Assessment Form that is sent with the HAS Referral to DCF
  3. 4. 30, a written description of the duties, responsibilities and qualifications required of an individual, bargained for position at DHCD.
  4. 6. (Notice of Placement Pending EA Eligibility) - A notice that informs the participant that they will be placed in Emergency Assistance (EA) Temporary Emergency Shelter pending full determination of their EA eligibility. This shelter placement is based on statements the applicant provided on the EA application and any other information provided to the Division.
  5. 7. of Information, A form used to give DHCD permission to obtain essential personal information about the applicant and all household members over the age of 18 that is needed to verify and make an EA eligibility determination
  6. 8. Checklist, A list of information that an EA HOH needs to request a PAAHM
  7. 9. Complaints, A form used by applicants and participants to file formal complaints at local field offices.
  8. 15. T, The form used to give notice of the termination of EA shelter services.
  9. 17. Accommodation Request, The form that is used to make a request for a change, exception, or adjustment to shelter accommodations that will allow a person with a disability to have an equal opportunity to use and enjoy a dwelling while in EA shelter, including public and common spaces.