151513;: Fig.5 Cuyahoga Job and Family Services PREVENTION ETENTION CONTINGENCY Program Manual June 2018 P.R.C. Program Manual Table of Contents (Left click on any topic to be taken to the corresponding page number) Topic Page Number Introduction 3 Non-financial Eligibility - Assistance Group Composition 4 - Residence 4 - Change in Circumstance/Mitigation 4 - Communitv Resources 5 - Sanctioned Individuals 5 - Ineligibilitv 6 Financial Eligibility - 200% Standard 6 - Liquid Assets 6 Verification 7 Scope of Coverage - Maximum Issuance 8 - Eliqible Categories 8 - Exclusions 10 - Limitations 10 Application Process - Application Filing 17 - Standard of Promptness 17 - Decisions 17 - Fraud 18 200% Povertv Standard Appendix A Income Exclusions Appendix Forms/Decision Reasons Appendix PRC Utilitv Assistance Referral Process Appendix P.R.C. Program Manual 2 Revised-June 2018 Prevention. Retention Contingencv Cuyahoga County?s PRC Program INTRODUCTION The Prevention, Retention and Contingency (P.R.C.) program has been established under Chapter 5108 of the Ohio Revised Code (ORC). It is designed to provide benefits and services to needy families and low-income employed families who are in need of help with essential supports to move out of poverty and become self?sufficient. The P.R.C. program provides flexibility forfunding a wide variety of employment and training activities, supportive services, and benefits that will enable individuals to obtain employment, maintain employment, and improve their economic circumstances. The supports provided under the P.R.C. program are limited to non?recurrent, short-term, crisis- oriented benefits and, ongoing services which do not meet the federal definition of assistance. Non?recurrent, short?term assistance addresses discrete crisis situations that do not provide for needs extending beyond four months. These benefits and services may encompass more than one payment per year, as long as the payment provides short?term relief and resolves a discrete crisis situation rather than meeting recurrent needs. These benefits and services are consistent with the federal definition of "non-assistance" as found in 45 CFR The definition of ?non-assistance? includes: 1. Non-recurrent, short-term benefits that: a) are designed to deal with a specific crisis situation or episode of need are not intended to meet recurrent or ongoing needs 0.) will not extend beyond four months 2. Work subsidies payments to employers to help cover the cost of employer wages, benefits, supervision, and training) 3. Supportive Services such as child care and transportation provided to families who are employed Refundable earned income tax credits Contributions to, and distributions from, Individual Development Accounts 6. Services such as counseling, case management, peer support, child care information and referral, transitional services, job retention, job advancement, and other employment?related services that do not provide basic income support; and 7. Transportation benefits provided under a Job Access or Reverse Commute project to an individual who is not otherwise receiving assistance. .0193 P.R.C. Program Manual 3 Revised-June 2018 NON-FINANCIAL ELIGIBILITY Assistance Group Composition P.R.C. benefits and services are available to a family assistance group which includes a minor child as defined in 5108.01 and 5108.06 and 5107.02 ofthe ORC orto pregnant individuals. Benefits and services are also available to the non?custodial parent of a minor child receiving Ohio Works First (OWF) cash assistance, Food Stamps and/or Medicaid. The non?custodial parent must reside in Cuyahoga County but not in the same household as the minor child. The PRC applicant must be a parent, caretaker, relative, legal guardian, or legal custodian of a minor child or be a pregnant individual. A child may be "temporarily absent? from the home in accordance with the timeframes established in rule 5101 :1?3?04 of the Ohio Administrative Code (OAC) and still qualify for P.R.C. benefits and services. During the "temporary absence? period, the child is considered to be residing with the parent, caretaker relative, legal guardian, or legal custodian. P.R.C. applicants who are in receipt of, or are eligible for OWF cash assistance will have their composition determined utilizing the existing Standard Filing Unit definition of an A16 for OWF eligibility (5101:1-23-10 Ohio Administrative Code). P.R.C. applicants who are not in receipt of, nor are eligible for, OWF cash assistance will have their AIG determined utilizing the existing definition of an A16 for Food Stamp eligibility (5101 :4?2?03 Food Stamp Certification Handbook). There are case situations in which more than one family or several families are living together in the same household. In these situations, it must be determined by the direct service staff person, which of the eligible household members will be included in the P.R.C. AIG. Application for and receipt of P.R.C. payments to multiple living together must be treated separately and requires an application for each The PRC applicant is defined as the adult completing the application. PRC applicants cannot be children, unless they meet the definition of minor head of household. Residence In order to be eligible to receive P.R.C. benefits and services at least one member of the NG must be a citizen ofthe United States or a qualified alien as defined in 5506(d) of Public Law 105? 33 (The Balanced Budget Act of 1997). P.R.C. benefits and services are available only to residents of Cuyahoga County. Residence is established by living in the County voluntarily with the intent to remain permanently or for an indefinite period of time. Residence is also established by an applicant who is not receiving assistance from another county and entered the county with a job commitment or seeking employment, whether or not currently employed. Change in Circumstance The applicant must be able to demonstrate that a specific change in circumstance occurred within the 12 months prior to the date of application for P.R.C. benefits or services that has contributed to the current, demonstrated need. Failure, by the applicant, to demonstrate the specific change will result in the applicant's ineligibility for P.R.C. benefits. The specific change in circumstance should be tied into the four allowable categories of PRC. The caseworker should first determine that the client meets one of the four allowable categories of PRC and then determine the change in circumstance that led to this. The change in circumstance leading to the current need must be an unexpected, life-altering event which may include, but is not limited to such things as: job loss or job gain, domestic violence, divorce, natural disaster or fire, individual providing monetary support leaves the household, death of a household member, new DCFS involvement in the household resulting in P.R.C. Program Manual 4 Revised-June 2018 the removal or threatened removal of a child, homelessness, accident resulting in the client not being able to work, addition of a child or other family member into the household, and prolonged illness. It does not include routine or expected changes such as: a voluntary move (not precipitated by any specific change in circumstance), change of seasons, start of a school year, inflation, holidays, sanction, legal infractions (including intentional fraudulent acts by the client such as intentionally breaking a lease), temporary and seasonal employment, and voluntarily terminating employment. For temporary employment, if no end date is Specified, the employment is not considered temporary if it has lasted six months or more. If any change in circumstance listed by the applicant is questionable, the caseworker may request documentation to verify that the change in circumstance occurred. Community Resources The availability of resources within the community shall be explored prior to the authorization of PRC. benefits or services. A P.R.C. is required to apply for and utilize any program, benefit or support system that may reduce or eliminate the current, demonstrated need. Workers, on behalf of the applicants shall utilize "United Way First Call for Help" to identify any available community resources. When United Way states that no community resources are available to meet the current need, the applicant is considered to have met this provision. The applicant will be required to explore at least one, but no more than three community resources when identified by United Way. - Housing Exception- Appropriate referrals will be made to community-based housing agencies based on the criteria established by each agency. When the client does meet the criteria of any community?based housing agency, no additional exploration of community resources is required. The P.R.C. application shall include a section to identify the community resources that must be explored prior to authorization of P.R.C. benefits and/or services. The applicant must provide verbal or written verification that the community resources identified were explored prior to the issuance of P.R.C. benefits/services. Sanctioned Individuals All OWF families must be in compliance with all provisions of the Self-sufficiency Contract and Self?sufficiency Plan at the time of application to be eligible for P.R.C. benefits and services. OWF sanctioned are eligible to receive P.R.C. benefits and/or services during the sanction period. However, if at the time of the PRC application, the client is within 30 days of the sanction or penalty period ending, the client must sign a new Self-Sufficiency contract, or waive OWF benefits if OWF is no longer desired. The Child Support worker in accordance with the Office of Child Support Services protocols will determine compliance for child support failures. P.R.C. benefits issued to OWF sanctioned families must be directly related to assisting the sanctioned member to comply with the provisions of his/her Self?sufficiency Contract/Plan. Failure ofthe P.R.C. applicant to demonstrate howthe issuance will assist the sanctioned member in achieving compliance will result in the denial of the PRC. application. P.R.C. Program Manual 5 Revised-June 2018 lneligibility Federal and State law (42 U.S.C. 608 section 431 of PRWORA and the ORC) prohibit the issuance of P.R.C.: 1. To families without a minor child 2. To a single individual, unless the individual is pregnant as verified by a licensed physician 3. For medical services except for pre?pregnancy family planning services 4. To an individual who is not a citizen of the United State or a qualified alien 5. To fugitive felons 6. To families that fraudulently receive or have received assistance under OWF and P.R.C. programs until repayment, in full, occurs (also known as an Intentional Program Violation) FINANCIAL ELIGIBILITY 200% Standard The P.R.C. must demonstrate and verify the need for financial assistance and/or services. The gross income of the NO must be equal to or less than 200% of the Federal Poverty Guidelines (FPG) for all P.R.C. direct services. The total gross income, earned and unearned shall be counted, excluding income and resources identified in 5101: 1?24-20 for P.R.C. and exempt income under Ohio Works First (OWF) and Food Assistance (see Appendix B). The applicant must utilize available income and resources in meeting the current, demonstrated need. This includes ongoing assistance programs such as OWF, DA, SSI, and food benefits, as well as unemployment compensation, social security, and the special energy assistance programs. Liguid Assets P.R.C. applicants with liquid assets greater than $1,000.00 are required to use any amount over $1,000.00 as a co?payment to meet the current, demonstrated need. There is no P.R.C. eligibility if the assistance group fails to make use of available income or resources that are in an amount sufficient to meet a portion of or the entire amount of the current, documented need. Liquid assets are those resources that are in cash or payable in cash upon demand. For P.R.C. purposes, liquid assets are those that can be converted to cash so that the funds are available to help meet the current, demonstrated need. The most common types of liquid assets are cash on hand, savings accounts, checking accounts, stocks, bonds, mutual funds, and promissory notes. Available liquid assets are those in which the assistance group member has a legal interest and the legal ability to use or dispose of them. If both legal interest and ability to use the liquid resources does not exist, the value of the liquid resource is unavailable for P.R.C. The resources to be considered for P.R.C. are those that are both liquid and available during the budget period to help the assistance group meet the current, demonstrated need. For P.R.C. purposes, resources do not include the value of real property, motor vehicles, life insurance (term or whole life policies), and household goods. Resources owned by one assistance group member are considered available to all other assistance group members. If ownership of a resource is shared by an assistance group member and a person who is not an assistance group member, the liquid asset is considered available on a prorated basis unless evidence is produced to show otherwise. For example, Mrs. Jones and her three children apply for P.R.C. She reports her savings account of $500 and another savings account which is jointly owned with her mother (who lives elsewhere) in the amount of $250. P.R.C. Program Manual 6 Revised?June 2018 Available assets to be considered in this instance are $625 unless Mrs. Jones supplies verification that a greater or lesser amount of the money in the joint account belongs to her or another member of her household. Lump-sum payments (excluding tax refunds) are to be considered income in the month in which they are received and any unspent balance will be counted as a resource. VERIFICATION The applicant must provide written verification of the need whenever possible. A P.R.C. applicant is responsible for completing all necessary documents, furnishing all available facts and information, and cooperating to the fullest extent in the eligibility determination process. Verification of income is required for P.R.C. Written or verbal verification from the source of the income must be obtained. Examples of acceptable verification are pay stubs, letter from the employer, award letter, and self?employment records. If an applicant fails to provide verifications required at the time of application, the applicant should be provided the ODJFS 7105, Application/Reapplication Verification Request Checklist, and be given 10 business days to provide the requested information. Phone verification, with the applicant?s signed ?Sharing of Information? form, is acceptable. Any verification that is obtained by phone must be clearly documented in the case record including the name and position of the person supplying the information, the date the verification was obtained, the current amount of the income, and the name of the individual who obtained the information. Verification of one estimate for each service or item approved must be provided. When P.R.C. benefits are issued through the use of a warrant, the applicant must provide written receipts, within ten business days, demonstrating that the PRC. funds were used for the intended purpose. The A16 is ineligible for any P.R.C. benefits and/or services until the receipts are provided to the agency. When the PRC. benefit to be issued is less than the amount required to meet the current, demonstrated need, the applicant must provide written verification that they have paid any amount required (over the amount of the PRC. payment) to meet the need, in full, prior to P.R.C. being issued. Verification of liquid assets is required. A current verbal or written statement from the source is acceptable verification. Examples are a passbook, statement, written notice, or a telephone call. The applicant?s statement is not acceptable as verification. Any verbal verification must be obtained from the financial institution, stock broker, etc. Due to the nature of the PRC. program, it is expected that verification be readily obtained. Therefore, phone verification with the applicant?s signed ?Sharing of Information? form is acceptable. Verification that is obtained by phone must be clearly documented in the assistance group record as to the name and position of the person supplying the information, the date the verification was obtained, the current amount of the resource, and the name of the individual who obtained the verification. P.R.C. Program Manual 7 Revised~June 2018 SCOPE OF COVERAGE Maximum Issuance Direct services are defined as benefits and/or services paid or issued that have direct monetary value to the adult. P.R.C. eligible adults may also receive non-direct services. Non?direct services are benefits and/or services that are not directly paid or issued to the adult and have no direct monetary value. P.R.C. applicants who meet all eligibility criteria may be eligible for up to $1,500.00 in the calendar year for direct good and/or services. The calendar year begins each January 1 and ends on December 31. The date of supervisor approval is the basis for the date of application. Non-custodial parents of children who are in receipt of Ohio Works First cash assistance, Food Stamps, and/or Medicaid are eligible for P.R.C. direct services. Non-custodial parents are eligible to receive up to $750.00 in a calendar year to assist them in obtaining or maintaining employment and/or training activities or meeting basic needs if there is a custody order through the Office of Child Support Services and visitation is not ordered. Some non-custodial parents may be eligible for up to $1,500 in a calendar year if there is a current support order through Office of Child Support Services and visitation is ordered and child support payments are current or the non? custodial parent is actively involved in job training, education, or employment?related activities. The direct services paid to the non-custodial parent will not count against the overall limit for the custodial parent?s P.R.C. Cuyahoga County will issue vouchers directly to vendors whenever possible. Warrants may be issued to the applicant as a last resort when no other avenue of issuance is available. Cuyahoga County retains final authority over the method of issuance. When the method of issuance is a voucher and the client does not redeem it within thirty days, the voucher is void. The voucher will not be re?issued but instead the client must file another application for P.R.C. if the need remains. Eligible Categories In addition to meeting all of the criteria establish in the previous paragraphs, an applicant must meet the criteria in at least one ofthe following categories to be eligible to receive direct services specific to a category of eligibility. Category 1- Employed individuals, persons seeking assistance in order to seek employment, or persons engaged in post-secondary education in an approved, accredited program. Families that are seeking employment (active with the Ohio Bureau of Employment Services or participating in a structured job search program), WEP, beginning new employment, or are attempting to maintain employment and are in need of short?term assistance to support their employment to prevent them from further or ongoing cash assistance. Individuals in need of short?term assistance for educational expenses, excluding tuition costs. P.R.C. issuance is limited to work-related or education-related, essential items. Issuance may include, but is not limited to: car repairs, work clothing, uniforms, testing fees, licensure fees needed to obtain or maintain employment; school equipment and/or supplies, and the cost of books. Category 2- Shelter Assistance Services Families that are seeking assistance for shelter costs limited to rent and/or security deposits, utility payments (Lead Poisoning Program ONLY), and utility shut?off notices. P.R.C. Program Manual 8 Revised?June 2018 Individuals referred via the Lead Poisoning Program: Benefits are limited to security deposit, utility deposits, and reasonable moving costs for moves within Cuyahoga County. Reasonable moving costs are not to exceed $250 A Lead Hazard Control Order or letter from a hospital stating that a child has been hospitalized due to lead poisoning, or evidence of a blood test showing the child has an elevated lead level of 5ug/dl or higher (indicating a blood-lead level of concern), is required for disbursement of funds for any type of service or benefit. If a family has exhausted their $1,500 of P.R.C. for the calendar year, or has already used their P.R.C. funds for housing assistance, they are eligible to receive an additional $750 for rent or security deposit, if the move is necessitated by having lead in their previous residence. A Lead Hazard Control Order or letter from a hospital stating that a child has been hospitalized due to lead poisoning, or evidence of a blood test showing the child has an elevated lead level of 5ug/dl or higher (indicating a blood-lead level of concern), is required for disbursement of funds. Lead Poisoning Program applicants must meet all P.R.C. program eligibility criteria outlined in the Cuyahoga Job and Family Services P.R.C. Program Manual. Exceptions will be noted. Verification that the Health Department has ordered applicant to vacate based upon the landlord?s failure to remediate identified lead hazards will prove "change in circumstance, as will a Lead Hazard Control Order, letter from a hospital stating that a child has been hospitalized due to lead poisoning, or evidence of a blood test showing the child has an elevated lead level of 5ug/dl or higher (indicating a blood-lead level of concern) Individuals referred via Red Cross PRC Program: Benefits are limited to security deposit, utility deposits, and reasonable moving costs for moves within Cuyahoga County. There is a maximum issuance of $1,500 for all items issued through the Red Cross P.R.C. program. The Red Cross/P.R.C. Application must be completed. This information will be entered by CJFS MIS staff so that all staff will be aware that an AG has received assistance through this program. If a family has exhausted their $1,500 of P.R.C. for the calendar year, or has already used their P.R.C. funds for housing assistance, they are eligible to receive an additional $750 for rent or security deposit, if the move is necessitated by a fire that has been verified by the Red Cross. Red Cross P.R.C. applicants must meet all P.R.C. program eligibility criteria outlined in the Cuyahoga Job and Family Services P.R.C. Program Manual. Exceptions will be noted. Individuals referred via Partners for Family Success Program: P.R.C. Program Manual 9 Revised-June 2018 Benefits are limited to security deposit, utility deposits, and reasonable moving costs for moves within Cuyahoga County and household items needed to establish a home There is a maximum issuance of $1,500 for all items issued through the Partners for Family Success P.R.C. program. The Partners for Family Success IP.R.C. Application must be completed. This information will be entered by CJFS MIS staff so that all staff will be aware that an AG has received assistance through this program. if a family has exhausted their $1,500 of P.R.C. for the calendar year, or has already used their PRC funds for housing assistance, they are eligible to receive an additional $750 for rent or security deposit, if referred'by Partners for Family Success Program. Partners for Family Success P.R.C. applicants must meet all P.R.C. Program eligibility criteria outlined in the Cuyahoga Job and Family Services P.R.C. Program Manual. Exceptions will be noted. Category 3- Families establishing or re-establishing a household Limited to: Individuals actively involved with the Department of Children and Family Services (DCFS) and/or the Department of Senior and Adult Services (DSAS). Applicants active with DCFS must; - Meet the Temporary Absence rule 5101:1-3-04 OAC, which specifies the ?temporary absence? time period as being no longer than six months from the removal date. I Have a reunification plan in place 0R - Have a case plan in place for the purpose of preventing children from being removed from the home. Applicants who have case plans in place with DCFS and the children are not in immediate risk of removal from the home do not meet eligibility in this category. Verification of a case plan from the DCFS worker is sufficient evidence?Hard copies of the case plan are not required. Individuals who are biological, adoptive or step-parents, specified relatives, legal guardians, or legal custodians who have taken minor children into their homes to care for within the past 12 months. These applicants could, but do not have to, be actively involved with DCFS and/or DSAS. Individuals actively involved with a domestic violence program Individuals actively involved with homeless program. P.R.C. issuance is limited to items such as furniture, appliances, and children?s clothing. Relocation expenses are only for moves within Cuyahoga County. Appli? cants requesting P.R.C. for housing assistance must also choose a residence within Cuyahoga County. P.R.C. Program Manual 10 Revised-June 2018 Exception: Families actively involved with Partners for Family Success intervention program. Category 4- Disaster Relief P.R.C. benefits and/or services are available to individuals who are in need of assistance due to damage and/or loss sustained as a result of fire or natural disaster upon declaration by the Governor. These include: Natural disasters such as flood, tornado, or blizzard. (Declared by the Governor of the State of Ohio Chemical disaster (Declared by the Governor ofthe State of Ohio) Fire Civil disorder (Declared by the Governor of the State of Ohio) individuals applying for P.R.C. for this reason must meet all financial and non-financial eligibility as outlined in the preceding sections. All applicable sub-limits for specific items apply. Exclusions Applicants may not utilize P.R.C. benefits: To meet a current, demonstrated need that is met through the issuance of benefits under another federal or state program. To directly pay court?ordered child support payments. To pay any costs associated with the violation of federal, state or local laws. This includes, but is not limited to; court costs, attorney fees, fines, and parking tickets. - Exception: P.R.C. benefits may be used to pay the reinstatement cost charged by the Ohio Bureau of Motor Vehicles for a driver?s license that was lost as a result of a violation of law, excluding DUI, if the driver's license is necessary to obtain or maintain employment. To pay fees associated with childcare including the childcare co-payment. To pay property taxes. To pay for any service listed in this policy due to bed bug infestation, unless the infestation results in a ?Notice of Condemnation" issuance forthe applicant?s place of residence due to building or health code violations that are not caused by the applicant (see Rent and/or Security Deposit payments section.) Applicants requesting services due to bed bug infestation should be referred to the Cuyahoga County Board of Health: To pay for any item(s) that requires additional financing over and above the PRC. issuance to meet the current, demonstrated need. Limitations citizens, non-qualified aliens, and/or fugitive felons PRC may not be used to provide direct benefits and/or services to non-US. citizens, non?qualified aliens, and/orfugitive felons. P.R.C. direct benefits and/or services may be provided to US. citizens in an with non-US. citizens and/or non-qualified aliens or to individuals in an with a fugitive felon. P.R.C. Program Manual 11 Revised?June 2018 The P.R.C. benefits and/or services issued under this circumstance cannot provide direct benefits and/or services to the non-US. citizen, non-qualified alien or fugitive felon. P.R.C. can be issued to purchase a bed for US. born child of non-US. citizen or non?qualified alien because the bed provides no direct benefit and/or service to the non-US. citizen and/or non-qualified alien. However, P.R.C. cannot be used to pay rent or purchase appliances because the issuance would provide a direct benefit and/or service to the non-US. citizen or non-qualified alien.) Rent andlor Security Deposit payments P.R.C. benefits for rental assistance is available only when there is evidence that the AlG?s current rent is delinquent by at least thirty (30) days or when there is evidence of a court proceeding concerning the occupancy of the rental unit. It is also available when the unit in which the applicant resides is foreclosed, or the landlord of a subsidized housing residence Section 8, CMHA), loses certification. In this case, the applicant must provide evidence that the building was foreclosed, but a court proceeding is not required. Client must demonstrate the ability to pay rent on an ongoing basis. Exception: Lead Poisoning Program PRC, Red Cross PRC and Partners for Family Success PRC applicants are not subject to the ?court proceeding? requirement. Evidence of a court proceeding includes, but is not limited to: - A summons to appear in housing court - A copy of the court's docket sheet showing that the applicant is scheduled to appear in housing court. - Any relevant court document(s) - A court-ordered eviction notice (known as a ?red tag? or ?Green tag? eviction notice). The date of the court proceeding must be within 30 days of the date of the P.R.C. application. P.R.C. benefits may be issued when a ?Notice of Condemnation? has been issued for the applicant?s place of residence due to building or health code violations that are not caused by the applicant. The "evidence of a court proceeding concerning the AlG?s occupancy of the rental unit? requirement is waived for individuals moving into an rental unit from a homeless shelter or domestic violence shelter, or if the applicant is working with a domestic violence service provider. The P.R.C. should only be issued for the applicant who is fleeing the domestic violence situation and not the perpetrator of the domestic violence. Verification is required from the shelter or domestic violence provider that the applicant was residing in the shelter or receiving domestic violence services. P.R.C. for rent and/or security deposit payments is only issued with a voucher. An applicant may receive P.R.C. for rent and/or security deposit assistance ONCE in the calendar year up to a maximum of $750.00. For applicants moving into a new apartment, one month of rent (based on the amount of rent stated in the lease) or the security deposit may be issued. For applicants needing past due rent to stay in their current apartment, two months of back rent (based on the amount of rent stated in the lease), may be issued. P.R.C. Program Manual 12 Revised-June 2018 Exception: Specifically, for pregnant women and parents with a medical crisis expected to last at least 3 months or longer, the maximum limit of $750 can be waived (issuance cannot exceed $1,500) if rent and/or security deposit is for diversion. The medical crisis must be diagnosed by a licensed medical practitioner in the last 6 months prior to the application date. An employability assessment is not required, and a statement by the licensed medical practitioner will verify the medical crisis. Exception: Families impacted by Lead Poisoning: if a family has exhausted their $1,500 of P.R.C. for the calendar year, or has already used their PRC funds for housing assistance, they are eligible to receive an additional $750 for rent or security deposit, if the move is necessitated by having lead in their previous residence. A Lead Hazard Control Order or letter from a hospital stating that a child has been hospitalized due to lead poisoning, or evidence of a blood test showing the child has an elevated lead level of 5ug/dl or higher (indicating a blood- lead level of concern), is required for disbursement of funds. Exception: Families impacted by fires and who complete the Red Cross P.R.C. Application If a family has exhausted their $1,500 of P.R.C. for the calendar year, or has already used their P.R.C. funds for housing assistance, they are eligible to receive an additional $750 for rent or security deposit, if the move is necessitated by a fire that has been verified by the Red Cross. If a family receives housing assistance through the Red Cross P.R.C. program and that issuance is the first issuance for housing assistance that year, they are not eligible for housing assistance again in that calendar year. There is a maximum issuance of$1 ,500 for all items issued through the Red Cross P.R.C. program. The fire must have occurred within 90 days of the P.R.C. application. The applicant must demonstrate that they are able to pay the rent on an ongoing basis (excluding the P.R.C. issuance) prior to the issuance of P.R.C. Exception: Families actively involved with Partners for Family Success intervention program If a family has exhausted their $1,500 of P.R.C. for the calendar year, or has already used their P.R.C. funds for housing assistance, they are eligible to receive an additional $750 for rent or security deposit, if the move is necessitated by Partners for Family Success in that calendar year. There is a maximum issuance of $1,500 for all items issued through the Partners for Family Success P.R.C. program. Furniture and appliances (excluding stoves and refrigerators) Applicant must meet eligibility requirements of Category 3 or 4. - Maximum of $400.00 (including tax) per item once every 5 years. - Furniture and appliance items are limited to the following: - Couches, Love Seats, Living Room Chairs, Kitchen Tables, - Bedroom Dressers, Microwave Ovens; - Washers/Dryers- Washers and Dryers must be integral to the applicant's employment child care provider who must maintain bed linens as part of the job) Cannot include entertainment items such as, radios/stereos, Players, televisions, and entertainment centers I Vouchers must be issued. Warrants will not be issued for furniture and/or appliances. P.R.C. Program Manual 13 Revised-June 2018 Utility Payments The "change in circumstance" provision is not required for utility assistance. The applicant must meet all other PRC requirements. Utility payments will be limited to no more than $750.00 in the calendar year for all combined issuances Utility bills are for electric, gas, water and sewer. Bills for kerosene, propane, or heating oil, supplied by a provider for heating or cooking, are also allowed. Utility assistance is limited to one time usage per unique utility per calendar year. The applicant must have a "shut-oft" notice from the utility company for a utility bill in his/her name. Cleveland Housing Network can only negotiate with the person(s) listed on the utility bill. Applicants who are required to pay the designated utility bill as part of their lease agreement, but whose name does not appear on the utility bill, do not qualify for P.R.C. ?Shut?off? notices for each utility are listed below: Columbia Gas: Applicant must provide a ?Termination Notice? Dominion/East Ohio Gas: Applicant must provide a letter that states that they have a "Shut-off Notice" or ?Final Bill" Illuminating CompanylFirst Energy (Electric): Applicant must provide a statement stating that there is a "Disconnection Notice? Cleveland Public Power (Electric): Applicant must provide a bill showing that they have a past due balance. Any applicant with a past due balance with CPP is in disconnection status. Cleveland Water: Applicant must provide a bill indicating a "Final Notice" or account is in "Shut-off" or "Delinquent Status" Exception: Lead Poisoning Program applicants do not have to meet the "shut?off? notice requirement, but bill has to be in applicant's name. Exception: Families actively involved with Partners for Family Success intervention program Exception: lfthe applicant needs utilities turned on in a new residence and cannot do this until a past shut-off notice or Letter of Debt (from the utility company) is addressed, P.R.C. may be authorized. When the Winter Crisis Program is available (for electric and gas bills) an applicant who meets the eligibility requirements of will not be issued P.R.C. unless there is evidence that an application was denied or was already used. Following Team Coordinator approval of the P.R.C application, the applicant must be referred to Cleveland Housing Network (CHN) for processing ofthe application. The applicant must be given the CJFS P.R.C. UTILITY ASSISTANCE REFERRAL form, which includes the P.R.C. Utility Assistance Referral Process- Cleveland Housing Network (CHN) P.R.C. payment will be limited to the amount negotiated by CHN to avoid the shut-off. CHN will require the client to enroll in the PIPP program (if applicable) prior to the issuance of P.R.C. if they are not already enrolled. Applicants under investigation for fraudulently tampering with meters should not be approved for P.R.C. even if they have a shut?off notice. P.R.C. Program Manual 14 Revised-June 2018 Applicants who receive a utility subsidy that meets or exceeds the PIPP (or other payment plan) are not eligible for P.R.C. for utilities Education and or work-related equipment Applicant must meet eligibility requirements of Category 1. Eligibility for education-related equipment costs is limited to an applicant who has been attending educational program for a minimum of 30 days. Exception-The applicant must be attending an educational program for a minimum of one week when the program's duration is 8 weeks or less. Education-related equipment costs are limited to no more than $500.00 (including tax) per calendar year. Education-related equipment does not include personal computers or laptops Education-related equipment does not include clothing required for training or work. See the section on Adult clothing for P.R.C. eligibility requirements Completion of a training/vocational program or class meets the change in circumstance requirement requesting assistance for testing fees Stoves and Refrigerators Beds P.R.C. Program Manual 15 Applicant must meet eligibility requirements of Category 3 or 4. P.R.C. for the purchase of a stove is limited to one per household, no more than $200.00 tax) once in a five-year period, and can only be issued through the use of a voucher. The five~year period begins on the day the PRC. payment is issued. P.R.C. for the purchase of a refrigerator is limited to one per household no larger than 18 cubic feet, no more than $200.00 tax) once in a five-year period, and can only be issued through the use of a voucher. The five-year period begins on the day the PRC. payment is issued. Exception: Red Cross PRC applicants are eligible for an addition $200 each for a stove and refrigerator, even if vouchers have already been issued for these appliances, and if they have already exhausted their $1,500 of P.R.C. in the calendar year. If a family receives these services through the Red Cross P.R.C. program and that issuance is the first issuance for those specific services that year, they are not eligible for those services again for a 5-year period. There is a maximum issuance of $1 ,500 for all items issued through the Red Cross P.R.C. program. Exception: Partners for Family Success P.R.C. applicants are eligible for an additional $200 each for a stove and refrigerator, even if vouchers have already been issued for these appliances, and if they have already exhausted their $1 ,500 of P.R.C. in the calendar year. if a family receives these services through the Partners for Family Success P.R.C. program and that issuance is the first issuance for those Specific services that year, they are not eligible for those services again for a 5-year period. There is a maximum issuance of $1 ,500 for all items issued through the Partners for Family Success P.R.C. program. Applicant must meet eligibility requirements of Category 3 or 4. Revised-June 2018 P.R.C. for the purchase of a bed (mattress/springs/frame) is limited to the following: Beds may only be purchased for children (exception listed below) PRC for adult beds is expressly prohibited. - The bed may be any size. - Maximum issuance is $250.00 tax) once in a five-year period for the same child. The five-year period begins on the day the P.R.C. payment issued. Exception: Adults who receive P.R.C. through the Red Cross P.R.C. Program are eligible for beds, up to $250 per adult. Red Cross PRC applicants are also eligible for an addition $250 per child per bed, even if vouchers have already been issued for children's beds, and if they have already exhausted their $1,500 of P.R.C. in the calendar year. If a family receives beds for children through the Red Cross PRC program and that issuance is the first issuance for children?s beds that year, they are not eligible for those services again for a 5~year period. There is a maximum issuance of $1 ,500 for all items issued through the Red Cross P.R.C. program. Exception: Adults who receive P.R.C. through the Partners for Family Success P.R.C. Program are eligible for beds, up to $250 per adult. Partners for Family Success P.R.C. applicants are also eligible for an additional $250 per child per bed, even if vouchers have already been issued for children?s beds, and if they have already exhausted their $1,500 of P.R.C. in the calendar year. if a family receives beds for children through the Partners for Family Success P.R.C. program and that issuance is the first issuance for children's beds that year, they are not eligible for those services again for a 5-year period. There is a maximum issuance of $1,500 for all items issued through the Partners for Family Success P.R.C. program. Children?s clothing Applicant must meet eligibility requirements of Category 3 or 4. P.R.C. for the purchase of children's clothing is limited to one issuance of no more than $150.00 tax) per child per calendar year period and can only be issued through the use of a voucher. Estimates are not required for children?s clothing. Exception: Red Cross P.R.C. applicants are eligible for an additional $150 per child, even if vouchers have already been issued for this service and if they have already exhausted their $1 ,500 of P.R.C. in the calendar year. If a family receives children?s clothing through the Red Cross P.R.C. program and that issuance is the first issuance for those children's clothing that year, they are not eligible for those services again in that calendar year. There is a maximum issuance of $1 ,500 for all items issued through the Red Cross P.R.C. program. Exception: Partners for Family Success P.R.C. applicants are eligible for an additional $150 per child, even if vouchers have already been issued for this service and if they have already exhausted their $1 ,500 of P.R.C. in the calendar year. If a family receives children's clothing through the Partners for Family Success P.R.C. program and that issuance is the first issuance for those children's clothing that year, they are not eligible for those services again in that calendar year. There is a maximum issuance of $1 ,500 for all items issued through the Partners for Family Success P.R.C. program. P.R.C. Program Manual 16 Revised-June 2018 Adult clothing Applicant must meet eligibility requirements of Category 1 or 4. P.R.C. for the purchase of adult clothing is limited to no more than $225.00 tax) per adult meeting eligibility in Category 1 per year. No more than $175.00 may be spent on clothing required for training, employment, and other program Specific needs per year. The applicant must show that the clothing is necessary to retain or obtain employment. The applicant must show verification of employment and provide documentation that the clothing is specifically necessary for the job. Employed recipients requesting clothing must meet the ?change in circumstance" provision. Estimates are not required for adult clothing. Exception: Red Cross P.R.C. applicants are eligible for $225 per adult, even if vouchers have already been issued for this service and if they have already exhausted their $1,500 of P.R.C. in the calendar year. The adult clothing issued through the Red Cross P.R.C. Program does not have to be tied to employment or training. An adult is eligible for additional clothing in that same calendar year, only if the clothing is necessary for employment or training. There is a maximum issuance of $1,500 for all items issued through the Red Cross P.R.C. program. Exception: Partners for Family Success P.R.C. applicants are eligible for $225 per adult, even if vouchers have already been issued for this service and if they have already exhausted their $1,500 of P.R.C. in the calendar year. The adult clothing issued through the Partners for Family Success P.R.C. Program does not have to be tied to employment or training. An adult is eligible for additional clothing in that same calendar year, only if the clothing is necessary for employment or training. There is a maximum issuance of $1,500 for all items issued through the Partners for Family Success P.R.C. program. Vehicle Repair Applicant must meet eligibility requirements of Category 1. m: The price ofthe vehicle repair cannot exceed the value of the vehicle. When the current, documented need is the repair of a vehicle, the applicant must meet all of the following criteria: - The car must be titled for a minimum of thirty days to the applicant, unless the applicant is leasing the vehicle, in which case documentation verifying the lease must be provided. - The cost of the repair cannot exceed $750.00 (including tax) or the documented value of the vehicle, whichever is lower, per year. - The repair must be completed by an ASE. certified mechanic. - The repair facility must agree to accept a voucher/purchase order from the county as payment. - The repair must make the vehicle sound. - Repairs are limited to unexpected changes (such as accidents and breakdowns, accidental flat tires, etc.) - Routine maintenance is not covered through P.R.C. and includes the following items: Oil changes (lube, oil, filter), replacement of any fluid transmission fluid, coolant, power steering fluid, brake fluid, etc), exterior lights, tires (unless replacement is needed due to an accident), windshield wipers, air conditioning unit, batteries, brake pads, spark plugs, radiator hoses, shock absorbers, and mufflers. P.R.C. Program Manual 17 Revised-June 2018 The applicant must have a current, valid driver?s license. The applicant must have current insurance coverage on the vehicle being repaired. The applicant must meet all other P.R.C. eligibility requirements. APPLICATION PROCESS Agplication Filing Any person has the right to apply for P.R.C. assistance. An individual requesting P.R.C. benefits and/or services must complete a P.R.C. application form (see Appendix C). The application and any other information gathered during the P.R.C. eligibility determination process should be kept in the OWF, Medicaid, and/or Food Stamp case record. If the PRC. NC is not receiving OWF, Medicaid, and/or Food Stamp assistance, a separate case record must be maintained for the PRC. application and related verifications. Additionally, PRC. benefits and/or services provided to non?custodial parents shall be kept in a separate file. Applicants who do not currently receive any other type of public assistance are encouraged to apply for PRC. benefits in the Neighborhood Family Service Center (N.F.S.C.) serving the geographical area in which they reside. Applicants who are employed, not in receipt of any other public assistance program, and unable to arrange for the application of PRC. benefits in the N.F.S.C. serving their neighborhood may apply at the N.F.S.C. that is most convenient. Applicants who are in receipt of another public assistance program must apply with the direct service staff person currently assigned to their case. Anyone applying for PRC. benefits and/or services must receive appropriate information about referrals to, and access to Medicaid, food stamps, child care assistance and other programs that provide benefits that could help them successfully transition to employment. Eligibility factors, time restraints, and amounts available to pay for various benefits and services covered must be explained and retained as part of the hard copy case record. It is also important to make voter registration applications as prescribed by the Secretary of State available to persons who are applying for, receiving assistance from, or participating in the PRC. program. P.R.C. assistance will be authorized with the expectation that the P.R.C. applicant is satisfied that the issuance will alleviate the current need. P.R.C. benefits and/or services may be issued for a specific type and episode of need to any once in a four-month period unless otherwise limited by this policy. The four-month period begins on the date that the PRC. funds were approved and runs for four consecutive calendar months. The term "specific type of need? is defined as the broad category of the item and/or service requested to meet the current, documented need. Refer to the coding chart contained in Appendix for the broad categories of need. (Example: A person requests boots and a winter coat for a child. The broad category for this type of need is "children?s clothing?. Therefore, the caseworker cannot issue any other children?s clothing items (even if it's for another child) until the minimum period has passed. Standard of Promptness The application of PRC. benefits and/or services is considered an application for public assistance. Cuyahoga County complies with Rule 5101:1-02-01 ofthe Public Assistance Manual governing the timelines that must be adhered to by the direct service staff persons in the processing ofthe PRC. application. The P.R.C. application will be approved or denied as quickly as possible, but no later than 10 calendar days once all required verifications are received from the applicant (as recommended by the ODJFS PRC. Reference Guide). The request for PRC. P.R.C. Program Manual 18 Revised?June 2018 funds form must be completed and forwarded for processing within one business day from the date of approval. Decisions Upon approval of P.R.C. benefits and/or services the ?Notice of Decision of Your Application for P.R.C. Benefits? shall be forwarded, in person or by US. mail, to the applicant within two (2) business days. The ?approval? box shall be marked with the appropriate reason and supporting regulation included. Once eligibility has been established, authorization for benefits and a payment, if required, should-be generated without delay. Payments will be made directly to vendors. Upon denial of the application for P.R.C. benefits and/or services the ?Notice of Decision of Your Application For P.R.C. Benefits? shall be forwarded, in person or by US. mail, to the applicant within two (2) business days. The ?Denied? box shall be marked with the appropriate reason and supporting regulation included. The applicant is afforded the right to due process to resolve diSputes related to the P.R.C. application. A P.R.C. application on behalf ofa deceased group member shall be denied regardless of whether the application was made before or after his/her death. If the remaining members of the assistance group are in need of P.R.C. benefits and/or services, their eligibility will be considered in manner consistent with this policy. FRAUD Suspected participant P.R.C. fraud will be referred to the Investigation Department for a fraud determination. The Coach or Specialist must utilize the Referral Form?f and CLRC in the system to refer to investigation Department and document the suspected participant fraud. Benefit Recovery screens are not to be used for referrals to the Investigation Department for suspected P.R.C. fraud. Provider P.R.C. fraud will be investigated by the Investigation Department and the Financial Audit Department resulting in potential prosecution. Approved by: @254 lChri?ty _Ni ol(l? Date ?lm Ad inis rator, Cuyahoga Job and Family Services P.R.C. Program Manual 19 Revised?June 2018 Cuyahoga Job and Family Services Appendix A, Federal Poverty Guidelines P.R.C. Program Manual JANUARY 2018 P.R.C. Program Manual 20 Revised-June 2018 P.R.C. Income Guidelines 200% of Federal Poverty Standard Revised 1-26-17 (FPG) Family Size Income Annual Income 1 $2,010 $24,120 2 $2,707 $32,480 3 $3,403 $40,840 4 $4,100 $49,200 5 $4,797 $57,560 6 $5,493 $65,920 7 $6,190 $74,280 8 $6,887 $81,640 For families/households with more than 8 persons, add $8,120 foreach additional person. P.R.C. Program Manual 21 Revised-June 2018 Cuyahoga Job Family Services Appendix Earned and Unearned Income Exclusions P.R.C. Program Manual JANUARY 2018 P.R.C. Program Manual 22 Revised?June 2018 OWF Earned Income Exclusions 5101 :1-23-20.1 Ohio Works First: Excluded Income CAMTL 104 Effective Date: November 1, 2015 Most Current Prior Effective Date: August 1I 2010 (A)What is excluded from gross earned income? (1)Al income excluded under the food assistance program regulations, as described in rule 5101:4-4-13 of the Administrative Code. (2)The gross earnings of a minor child in the assistance group who is a full-time student as defined by the school, unless the minor is a parent. Minor child is defined in section 5107.02 of the Revised Code. (3)Chi d support payments paid by an assistance group member for a child outside the assistance group, up to the amount ordered. (4)The verified amount garnished from the income. (5)Exclusions from self-employment income as described in rules 5101:1-23-20, 5101:4- and 5101:4-6-11 of the Administrative Code. A deduction claimed as personal business and/or entertainment expense is not an allowable deduction from self- employment income. (6)Exclusions from a microenterprise development set forth in rule 5101:1-23-20 of the Administrative Code. (7)Earned income tax credit payments whether added to the individual's wages or as part of an income tax refund. The individuals wages must be subject to federal withholding or Federal Insurance Contributions Act, 68A Stat. 415 (1954), 26 U.S.C. 3128, (FICA) taxes. (8) ncome received due to temporary employment with the bureau of the census for a decennial census. (9)Any other income amounts that federal statutes or regulations and sections 5101.17 and 5117.10 of the Revised Code require be excluded. (B)What is excluded from gross unearned income? income excluded under the food assistance program regulations, as described in rule 5101:4-4-13 of the Administrative Code. (2)lncome of a recipient of supplemental security income (SSI), including the SSI payment. (3)lncome of a child for whom federal, state or local foster care maintenance payments are made, including the foster care payment. (4) ncome of step siblings who are not included in the assistance group. (5)Payments made with county funds to increase the amount of cash assistance an assistance group receives in accordance with the provisions set forth in section 5107.04 of the Revised Code. (6)Child support payments paid by an assistance group member for a child outside the assistance group. The amount paid, up to the amount ordered, is excluded. P.R.C. Program Manual 23 Revised-June 2018 (7)Contributions for shared living arrangements cash payments received by an assistance group from an individual who is not an assistance group member but who resides in the household with the OWF assistance group and shares responsibility for the household expenses through an informal arrangement). (8)Benefits received under Title VII, nutrition program forthe elderly, Older Americans Act of 1965, Pub. L. No. 89?73, (7/14/1965), title Section 339, as added, Pub. L. 106-501, title Section 313, (11/13/2000), 114 Stat. 2252. (9)0ther payments made by a public or private agency for the purposes of supplementing standards, so long as there is no duplication of payment. (10)Retroactive payments made as a result of a state hearing. (11)Experimental housing assistance payments made under annual contributions on contracts entered into under Section 237(f)(2) ofthe United States Housing Act of 1937 (42 U.S.C. 1421b), as in effect before 1/1/1975. (12)Housing and urban development (HUD) community development block grant funds paid under Title of the Housing and Community Development Act of 1974 Pub. L. No. 93-383, (8/22/1974), 42 U.S.C. 5303, as amended 10/28/92. (13)Home energy assistance support and maintenance paid in cash or in kind, Pub. L. No. 97-377 (12/21/1982), Pub. L. No. 97-424 (1/06/19831, and Pub. L. No. 98?21 (4/20/19831. (14)Payments received under the provisions of the "Aroostook Band of Micmacs,? Pub; &102-171, 25 U.S.C 1721, (11/26/1991). (15)The verified amount which is garnished from the income. (16)Earned income tax credit payments. (17)Any other income amounts that federal statutes or regulations and sections 5101.17 and 5117.10 of the Revised Code require be excluded. (18)Kinship permanency incentive (KPI) payments made in accordance with the provisions set forth in rule 5101:2-40-04 of the Administrative Code. (19)The supplemental weekly unemployment compensation payments paid under the Worker, Homeownership, and Business Assistance Act of 2009 (Pub. L. No. 111? 9_2, 26 U.S.C. 3304, (1 1/06/200911. P.R.C. Program Manual 24 Revised?June 2018 FAH.4000. Financial Criteria and Eligibility Determination 5101 :4-4-13 Food Assistance: Types of Excluded income FATL 339 Effective Date: September 1, 2013 Most Current Prior Effective Date: September 1. 2010 In the Food and Nutrition Act of 2008 congress specified the types of income that are excluded for program purposes. The following payments shall be excluded as income: (3mm; gain or benefit that is not in the form of money payable directly to the assistance group including in-kind benefits. ln-kind benefits are those for which no monetary payment is made on behalf of the assistance group and include meals. clothing. public housing. or produce from a garden. (B)Payments made to a third party on behalf ofthe assistance group are included or excluded as income as follows: (1)Public assistance, including disability financial assistance (DFA), vendor payments are counted as income unless they are made for medical assistance. child care assistance. energy assistance as defined in paragraph (I) (4) of this rule, emergency assistance (including, but not limited to housing and transportation payments) for migrant or seasonal farm worker assistance groups while they are in the job stream. or housing assistance payments made through a state or local housing authority. (2)Public assistance provided to a third party on behalf of an assistance group that is not specifically excluded from consideration as income under paragraph of this rule shall be considered for exclusion under the emergency and Special assistance category. To be considered emergency or special assistance and excluded. the assistance must be provided over and above the normal public assistance payment or cannot normally be provided as part of such payment. L3)Reimbursements made in the form of vendor payments. monetary payments made on behalf of an assistance group by a person or organization outside ofthe assistance group directly to either the assistance group's creditors or to a person or organization providing a service to the assistance group. are excluded on the same basis as reimbursements paid directly to the assistance group in accordance with p_aragraph (E) of this rule. El?n-kind or vendor payments that would normally be excluded as income but are converted in whole or in part to a direct cash payment under a federally authorized demonstration proiect or waiver shall be excluded from income. (5)Rent or mortgage payments made to landlords or mortgagees by the department of housing and urban development (HUD) are excluded. (6)Monies that are legally obligated and otherwise payable to the assistance group, but which are diverted by the provider of the payment to a third party for a household expense, shall be counted as income and not excluded. If a person or organization makes a payment to a third party on behalf of an assistance group using funds that are not owed to the assistance group. the payment shall be excluded from income. (C)The county agency shall exclude any income that is specifically excluded by any other federal statute from consideration as income for the purpose of determining eligibility for the food assistance program. The following is a listing of some of the incomes excluded by federal P.R.C. Program Manual 25 Revised?June 2018 statute. The listing is divided into general income exclusions and exclusions applicable to incomes of American Indians or Alaska Natives. (1)Genera exclusions (a)lncome of a supplemental security income (SSI) recipient determined necessary for the fulfillment of a plan for achieving self-support (PASS) which has been approved under section or 1812(b)(4)(B)(iv) of the Social Security Act of 1935. This income may be spent in accordance with an approved PASS or deposited into a PASS savings account for future use. (b)Federal emergency management assistance housing subsidies to pay for temporary housing required as a result of a disaster and individual and family grant assistance payments made under the Disaster Relief Act section 312(d) of the Disaster Relief Act of 1974. as amended in 1988 by Pub. L. No. 100-707. (11/1988). (c)Assistance provided to children under the school lunch program. the summer food service program for children, the commodity distribution program and child and adult care food program (CACFP), Pub. L. No. 79-396. (08/1948), section 12(e) of the National School Lunch Act of 1946, as amended by section 9(d) of Pub. L. No. 94-105. (10/1975). (d)Assistance provided to children under the special milk program. special supplemental food program for women. infants. and children (WIC) and the school breakfast program. Pub. L. No. 89-842. (10/1968), the Child Nutrition Act of 1988, section 11(b). (e)Reimbursements from the Uniform Relocation Assistance and Real Property (f)Pub. Acquisition Policy Act of 1970. Pub. L. No. 91?648. section 218 (02/1971). L. No. 93-113, (10/1973). the Domestic Volunteer Services Act of 1973. Titles I and II. Payments under Title I of the act (including such Title I programs as volunteers in service to AmeriCorps (VISTA). university year for action. and urban crime prevention program) to volunteers shall be excluded for those individuals receiving food assistance or public assistance at the time they ioined the Title I program. except that assistance groups which were receiving an income exclusion for a VISTA or other Title subsistence allowance at the time of conversion to the Food and Nutrition Act shall continue to receive an income exclusion for VISTA for the length of their volunteer contract in effect at the time of conversion. Temporary interruptions in food assistance participation shall not alter the exclusion once an initial determination has been made. New applicants who were not receiving public assistance or food assistance at the time they ioined VISTA shall have these volunteer payments included as earned income. Any payment to volunteers under Title II (retired senior volunteer program. foster grandparents, senior companion program and others) are excluded from income. (g)Payments received under section 312(d), the Disaster Relief Act of 1974, Pub. P.R.C. Program Manual L. No. 93?288, (05/1974). as amended by section 105(i). the Disaster Relief and Emergency Assistance Amendments of 1988, Pub. L. No. 100?707, (11/1988). Payments precipitated by an emergency or maior disaster as defined in this act. as amended, are not counted as income for food 28 Revised~June 2018 assistance purposes. This exclusion applies to federal assistance provided to persons directly affected and to comparable disaster assistance provided by states, local governments, and disaster assistance organizations. A "maior disaster? is any natural catastrophe such as a hurricane or drought, or. regardless of cause. any fire, flood. or explosion, which the president of the United States determines causes damage of sufficient severity and magnitude to warrant maior disaster assistance to supplement the efforts and available resources of states, local governments, and disaster relief organizations in alleviating the damage, loss, hardship, or suffering caused thereby. An "emergency" is any occasion or instance for which the president of the United States determines that federal assistance is needed to supplant state and local efforts and capabilities to save lives and to protect property and public health and safety, or to lessen or avert the threat of a catastrophe. Most, but not all, federal emergency management assistance funds are excluded. For example, some payments made to homeless people to pay for rent, mortgage, food. and utility assistance when there is no maior disaster or emergency is not excluded under this provision. (h)Payments to US. citizens of Japanese ancestry and permanent resident Japanese aliens or their Survivors and Aleut Residents of the Pribilof Islands and the Aleutian Islands West of Unimak lsland, Pub. L. No. 100- 383. (08/1988), section 105(f) (2), wartime relocation of civilians, the Civil Liberties Act of 1988. (i)lncome received (including reimbursements) by individuals participating in mgrams under the Workforce Investment Act (WIA) of 1998, section 181 except as provided in rule 5101:4-4-19 of the Administrative Code. This includes disaster relief employment income received from national emergency grants under the Pub. L. No. 105-220. (08/1998) section 181(a) (2). (i)Any amount by which the basic pay of an individual is reduced and reverted to the treasury shall not be considered to have been received by or to be within the control of such individual. Pub. L. No. 99-576, (08/1986) section 303(a)(1), Veteran's Benefits Improvement and Health Care Authorization Act of 1986, which amends section 1411(b) and 1412(c) of the Veteran's Educational Act of 1984 - GI bill. (k)Funds received by persons fifty-five and older under the senior community service employment program under Title of the Older Americans Act of 1987 are excluded from income, Pub. L. No. 109-385, (10/2008). The organizations that receive some Title funds are as follows: experience works; national council on aging; national council of senior citizens; American" association of retired persons; United States forest service; national association for Spanish speaking elderly; national urban league; and the national council on black aging. ( )Cash donations based on need received on or after February 1. 1988 from one P.R.C. Program Manual or more private nonprofit charitable organizations, but not to exceed three hundred dollars in a federal fiscal year quarter. Charitable Assistance and Food Bank Act of 1987, Pub. L. No. 100-232, (01/1988). 27 Revised~June 2018 (m)Food assistance benefits that may be exchanged for food at farmers' markets under WIC demonstration proiects. Pub. L. No. 100-435, (09/1988) section 501. which amended section 17(m) (7) of the Child Nutrition Act of 1988. (n)Payments made from the Agent Orange settlement fund, Pub. L. No. 101-201, (12/1989), or any other fund established pursuant to the settlement in the Agent Orange product liability litigation, M.D.L. No. 381 (E.D.N.Y.) (01/1989) which are received on or after January 1, 1989. The disabled veteran will receive yearly payments. Survivors of deceased disabled veterans will receive a lump-sum payment. These payments were disbursed by Aetna insurance company. The Omnibus Budget Reconciliation Act of 1989. Pub. L. No. 101-239, (12/1989), also excludes these payments. Pub. L. No. 102?4, (02/1991), Agent Orange Act of 1991, authorized veterans' benefits to some veterans with service-connected disabilities resulting from exposure to Agent Orange. These VA payments are not excluded by law. (o)Payments made under the Radiation Exposure Compensation Act, Pub. L. No. 101-426, (10/1990) section as amended by Pub. L. No. 108-245 (07/2000). (p)The Omnibus Budget Reconciliation Act of 1990, Title XI revenue provisions, section 11111, modifications of earned income tax credit. subsection provides that any federal earned income tax credit shall not be treated as income effective with taxable years beginning after December 31, 1990, Pub. L. No. 101-508, (11/1990). (q)Pub. L. No. 101-610, (11/1990), National and Community Service Act (NCSA) of 1990, section 177(d), applies to prolects conducted under Title I of the NCSA. Title I includes three acts: Serve?America: the Community Service, Schools and Service-Learning Act of 1990. (ii) the American Conservation and Youth Service Corps Act of 1990. and the National and Community Service Act. There are about forty-seven different NCSA programs. and they vary by state. Most of the payments are made as a weekly stipend or for educational assistance. The higher education service-learning program and the AmeriCorps umbrella program come under this title. The national civilian community corps is a federally managed AmeriCorps program. The summer for safety program is an AmeriCorps program under which participants earn a stipend and a one thousand-dollar post service educational award. The Serve America Act. Pub. L. No. 111-13, (04/2009), amended the National and Community Services Act of 1990 but it did not change the exclusion. All AmeriCorps payments shall be excluded. (r)All student financial assistance, including grants, scholarships, fellowships, P.R.C. Program Manual educational loans on which payment is deferred, work study, veterans' educational benefits, and the like, which are awarded to an assistance group member enrolled at a recognized institution of post?secondary education, at a school for the handicapped, in a vocational education program, in a vocational or technical school. or in a program that provides for obtaining a secondary school diploma or the equivalent of a secondary school diploma shall be excluded from consideration as income for food assistance purposes. 28 Revised-June 2018 Educational income excluded for dependent care costs shall not be deducted from income under the provisions of rule of the Administrative Code. Dependent care costs incurred which exceed the amount excluded under the provisions of this paragraph shall be deducted from income in accordance with rule 5101:4-4-23 of the Administrative Code. (s)Payments made under the youthbuild program under the Housing and Community Development Act of 1992. Pub. L. No. 102-550. (10/1992). The youthbuild program transferred from the United States department of housing and urban development to the department of labor with the passage of the Youthbuild Transfer Act of 2006. Pub. L. No. 109-2811 @0006). which amended the Workforce Investment Act of 1998. These payments are to be treated like payments in accordance with paragraph of this rule. except as provided in rule 5101:4-4-19 of the Administrative Code. (t)Payments from any child care provided or arranged (or any amount received as payment for such care or reimbursement for costs incurred for such care). Pub. L. No. 102?586, (11/1992) section 8, which amended the Child Care and Development Block Grant Act Amendments of 1992 by adding section 6588. (u)Payments made to individuals because of their status as victims of Nazi persecutionl Pub. L. No. 103-286, (08/1994). L. NO. 103-322. (09/1994) section 230202. amended section 1403 of the Crime Act of 1984 (42 U.S.C. 10802) to provide in part that. Notwithstanding any other law, if the compensation paid by an eligible crime victim compensation program would cover costs that a federal program, or a federally financed state or local program, would otherwise pay. such crime victim compensation program shall not pay that compensation; and (ii) the other program shall make its payments without @gard to the existence of the crime victim compensation program.? Based on this language, payments received under this program must be excluded from income for food assistance purposes. (wwotwithstanding any other provision of law, the allowance paid under Pub. L. No.104-204. (09/1996) section 1805(d), as amended by Pub. L. No. 106- 419, (11/2000), to a child of a Vietnam veteran for any disability resulting from spina bifida and certain other birth defects suffered by such child. A allowance from two hundred to one thousand two hundred dollars is paid to a child under this public law. (x)Additional pay received by military personnel as a result of deployment to a P.R.C. Program Manual combatzone (underthe Consolidated Appropriations Bill, 2008, Pub. L. No. 110-161. (12/2007). The additional combat pay shall be determined as follows: (i)Establish what amount for food assistance purposes of the military person's pay that was actually available to the assistance group prior to the deployment of the military person to a designated combat zone. 29 Revised-June 2018 (allf the military person was part of the assistance group for food assistance purposes prior to the deployment, this amount would be his or her net military pay. (b) fthe military person was not part ofthe assistance group for food assistance purposes prior to the military person's deployment to a designated combat zone, this amount is the amount the absent military person actually made available to the assistance group prior to deployment to the designated combat zone. (ii)Determine the amount of military pay that the absent member deployed in a designated combat zone is making available to his or her family. the amount of military pay that the absent member deployed in a designated combat zone is making available is equal to or less than the amount the assistance group was receiving from the military person prior to deployment to a designated combat zone. all of the military pay would be counted as income to the assistance group for food assistance purposes. Any portion of the amount that exceeds the amount the assistance group was receiving prior to deployment of the military person to a designated combat zone shall be excluded when determining the assistance group's income for food assistance purposes. (y)Disaster unemployment assistance provided under the Robert T. Stafford Disaster Relief and Emergency Assistance Act, Pub. L. No. 100?707. (11/1988), to individuals unemployed as a result of a maior disaster. (z)Filipino veterans equity compensation funds payments under the American Recovery and Reinvestment Act of 2009 (02/2009, Pub. L. No. 111-5) made to certain veterans, or surviving spouses of veterans, who served in the military of the government of the commonwealth of the Philippines during World War ll. (aa)Any aid, services, or incentives provided to an eligible beneficiary participating in programs funded by the health profession opportunity grants (HPOG) under the Patient Protection and Affordable Care Act of 2010, Pub. L. No. 111-148, (03/2010). (2)Payments made to American Indians or Alaska Natives that are excluded by law. A list of funds provided to American Indians or Alaska Natives that are excluded by law can be found at: Excluded Native American Funds 2011.Ddf (D)All loans, including loans from private individuals as well as commercial institutions, are excluded as income. Educational loans on which repayment is deferred shall be excluded pursuant to the provisions in paragraph ofthis rule. (E)Reimbursements for past or future expenses are excluded to the extent they do not exceed actual expenses and do not represent a gain or benefit to the assistance group. No portion of benefits provided under Title of the Social Security Act of 1935, to the extent such benefits are attributed to adiustment for work-related or child care expenses shall be considered excludable under this paragraph. P.R.C. Program Manual 30 Revised-June 2018 (1)When a reimbursement, including a flat allowance, covers multiple expenses, each expense does not have to be separately identified as long as none of the reimbursement covers normal living expenses. Reimbursements for normal living expenses of the assistance group, such as rent or mortgage, personal clothing, or food eaten at home. are a gain or benefit and therefore are not excluded. To be excluded, these payments must be provided specifically for an identified expense, other than normal living expenses, and used for the purpose intended. (2)The amount by which a reimbursement exceeds the actual incurred expense shall be counted as income. However, reimbursements shall not be considered to exceed the actual expenses, unless the provider or the assistance group indicates the amount is excessive. (F)Monies received and used for the care and maintenance of a third-party beneficiary who is not an assistance group member. If the intended beneficiaries of a single payment are both assistance group and non-assistance group members, any identifiable portion of the payment intended and used for the care and maintenance of the non-assistance group member shall be excluded. if the non-assistance group member?s portion cannot be readily identified, the payment shall be evenly prorated among intended beneficiaries and the exclusion applied to the non-assistance group member's pro rata share or the amount actually used for the non?assistance group member's care and maintenance, whichever is less. (G)The earned income of any assistance group members who live with a natural, adoptive, or stepparent, or under the parental control of an assistance group member other than a parent, who are elementary or secondary school students. and who are seventeen years of age or younger. For purposes of this provision, an "elementary or secondary school student" is someone who attends classes to obtain a general equivalency diploma (GED) that are recognized, operated, or supervised by the student?s state or local school district. The provision also applies to a student who attends elementary or secondary classes through a home-school program recognized or supervised by the student?s state or local school district. This income is excluded even during temporary interruptions in school attendance due to semester or vacation breaks, provided the child's enrollment will resume following the break. If the child?s earnings or the amount of work performed cannot be differentiated from that of other assistance group members, the total earnings shall be prorated equally among the working members and the child?s pro rata share excluded. Individuals are considered children for this exclusion if they are under the parental control of another assistance group member. If an assistance group contains a student whose income is excluded and the student turns eighteen during the month of application, the student?s earnings shall be excluded in the month of application and counted in the following month(s). If the student turns eighteen during the certification period, the student's income shall be excluded until the month following the month in which the student turns eighteen. (H)Money received in the form of a nonrecurring lump-sum payment, including, but not limited to, income tax refunds, rebates, or credits; retroactive lump?sum social security, SSI, public assistance, railroad retirement pension, the learning, earning and parenting (LEAP) program enrollment bonus payment, or other payment; retroactive lump-sum insurance settlements; refunds of security deposits on rental property or utilities; medical loss ratio rebates afforded under the Patient Protection and Affordable Care Act of 2010, Pub. L. No. 111,148 (03/2010); or prevention, retention and contingency (PRC) payments made to divert an assistance group from becoming dependent on cash assistance ifthe payment is not defined as assistance. Temporary assistance for needy families (TANF) non? recurrent, short term benefits are defined in 45 CFR (revised October 1, P.R.C. Program Manual 31 Revised-June 2018 2001). These payments shall be counted as resources in the month received. unless specifically excluded from consideration as a resource by other federal laws. (l)Miscellaneous income exclusions. (1)Irregu ar income Any income in the certification period that is acquired too infrequently or irregularly to be reasonably anticipated. but not in excess of thirty dollars in a quarter. (2)Costs of self-employment The cost of producing self?employment income. See rule 5101:4-6-11 of the Administrative Code for the procedures on computing the cost of producing self- empioyment income. (3)1ncome from ineligible assistance group members The prorated share of earned or unearned income of an ineligible assistance group member in accordance with rule 5101:4-6-13 of the Administrative Code. (4)Energy assistance. as follows: (a)Any payments or allowances made for the purpose of providing energy assistance under any federal law other than part A of Title IV of the Social Security Act of 1935 (42 U.S.C. 601). including utility reimbursements made by HUD and the rural housing service. or (b)A one-time payment or allowance applied for on an as-needed basis and made under a federal or state law for the costs of weatherization or emergency repair or replacement of an unsafe or inoperative furnace or other heating or cooling device. A down payment followed by a final payment upon completion of the work will be considered a one?time payment for purposes of this provision. (5)Blood and blood plasma sales Any income which is acquired from the sale of blood or blood plasma. (61Garage sales Any income which is acquired from garage sales. (71lnterest income Any interest income from savings or other financial accounts. (8)Bingo winnings Any income from bingo winnings. (J)Certain payments from the child and adult care food program That portion of payments from the child and adult care food program to assistance groups providing child care services intended for the provider's own children's meals. See paragraph of rule 5101:4-4-19 of the Administrative Code for treatment of that portion of child and adult care food program payments intended for providing services to children other than the provider's own. P.R.C. Program Manual 32 Revised?June 2018 (K)Payments which are not considered income. (1)Monies withheld from an assistance payment, earned income, or other income source, or monies received from any income source which are voluntarily or involuntarily returned to repay a prior overpayment received from the income source, provided that the overpayment is not otherwise excluded. However, monies withheld from assistance from a federal, state, or local means-tested program (for example, Ohio works first (OWF) or DFA) due to the assistance group's failure to perform an action required under these proqrams, shall be included as income in accordance with rule 5101 :4-6-16 of the Administrative Code. (2)Chi d support payments received by OWF recipients which must be transferred to the agency administerinq Title IV-D ofthe Social Security Act of 1935 to maintain OWF eligibility. (3)Govemmenta or court-ordered foster care payments received by assistance qroups with foster care individuals who are considered to be boarders. P.R.C. Program Manual 33 Revised-June 2018 we 1:1" Cuyahoga Job and Family Services Appendix Forms P.R.C. Program Manual JANUARY 2018 P.R.C. Program Manual 34 Revised-June 2018 Cuyahoga County Cuyahoga Job and Family Together We Thrive Prevention, Retention and Contingency PRC Application I Date Sent I Date nausea Applicant Contact Information I rennin. tirade minim Initial Street Address City State Zip Code Social Security it Case it Date of Telephone! Citizenship Race Sex Male 3 Female Applicant must complete the lollowing information. 1. Explain the speci?c change in circumstance that has occurred to you and your lamty in the last year that led to your PRC application, and glue the assistance you are requesting. and include amount needed. {attach applicant's written explanation of need. if needed). 2. Give the name ol other agencies you have contacted ior help. 3. Comdete the chart below for anyone lying in your home, including yourself. Income veri?cation may be required. Name u.s. Relationship Date Sex Race Sourceoltncoms citizen? . mentionany member of your household has any ol the resources listed below, check yes beside the item and compiete the line. Otherwise check no. income verification may be required. Resource Yes No Person with Resource Amount Cash on Hand anvil-gs Appoint Checking Account Trait Fund Stocks or Bonds 0559': 5M Any attempt to apply tor P.R.C. bene?ts fraudulently shall be prosecuted under the Ohio Revised Code. Any voucher or check issued with a speci?c intent that is redeemed, cashed, or used for anything other than this intended emergency application shall be charged with a theft offense. By signing this application Iagree to previde documentation to verify the need for services and items I am requesting. Failure to provide requested documentation may result in denial oi the application. Applicant Signature Date CJFS 330 SPF (Ole?OISJrev. r1425 Does applicant meet all eligibility criteria? a Yes (Please refer to eligibility section on p. 2 of the PRC. policy manual.) For Money UseOnly UlN?l Date Application Received (MilliDDiYY) 30 Day Budget Period from to Community Resources ., .. Agency Amount ltemlServlee 3. Reaourceailncome Source oi Resources Amount Available In Veri?cation BudgetPeriod 3 TOTAL RESOURCES 5 Compare to Maximum Roaouroe Limit Source oi bacon-re Amount Available in Veri?cation BudgelPeriod 5 TOTAL INCOLIE 3 Compare to 200% oi Federal POvorty Guidelinea Mimi 1365-6.in t3 P.R.C. Approved Date Approval Notice Sent . t3 P.R.C. Denied Date Denial Notice Sent Reason iorDenial Caseworker Signature Date Team Leader Signature Date Center Managern'eam Coordinator Signature Date 2 CJFS 33o ser- (01f2018)rev.l 1425 . . . . Of?ce Use Only Ohio Department of Job and Family Servrces Applicant/Recipient Name First Name Last Name Case Number AUTHORIZATION FOR RELEASE OF . INFORMATION Name of CDJF Representative Unique Identi?er Date I, hereby authorize to disclose (Name of Individual) (Name of covered entity, such as CDJF S, employer, etc.) The information listed below to for the purpose of determining (Who will receive the information?) Eligibility for cash assistance, medical assistance and/or food stamp bene?ts; or for the following reason(s): Information to be released: By signing below, I understand that: This authorization shall expire on or until revoked by me in writing, whichever comes first. (Date or completion of ?event?-reason the signed authorization is needed) I have the right to revoke or cancel this authorization at any time by providing notice in writing to the following address: The revoking or canceling of this authorization does not affect the use 0r disclosure of information that occurred prior to the date that the authorization was canceled. Any information used or disclosed as per this specific authorization may be re-disclosed by the person or entity receiving the information. In Such as situation, it may no longer be protected by federal or state law. This authorization is NOT for the release or use of protected health information (PHD-please use the appropriate medical release authorization form. I am aware of my responsibilities to report completely and fully all facts that bear upon my eligibility for all cash assistance, medical assistance andfor food stamp benefits. I realize if the requested information reveals I have improperly reported my situation, the information may be given to the prosecuting attorney for possible civil action or criminal prosecution. Completion of this form is voluntary, but necessary to determine eligibility for cash assistance, medical assistance andi?or food stamp benefits. Signature of Applicantr'Reeipient or Authorized Representative Date Representative?s Legal Authority to Applieantr?Recipient (Such as parent, guardian, power ofattorney, authorized rep. etc.) Please reply in the Space below, sign and date. Signature/Title of Person Supplying Information Telephone Number Date NOTICE OF DECISION OF YOUR APPLICATION FOR P.R.C. BENEFITS Name Assistance Group Name Streel Address Case Number Program City, State, and Zip County Mailing Date Your application for P.R.C. benefits signed on has been: Approved Denied Reason: The regulation supporting this decision is: if you do not understand this notice, or want to talk to someone about it, you may call: Telephone number Your Right to a State Hearing This notice is to tell you about action we are taking on your case. If you do not understand this action, you may contact your caseworker. After talking with your caseworker, it is possible that we will change our decision or that you will agree with the action. If you do not agree with this action, you have a right to a state hearing. A state hearing lets you or your representative(lawyer, welfare rights worker, friend or relative) give your reasons against the action. We will also attend or be represented at the hearing to present our reasons. A hearing officer from the Ohio Department of Human Services will decide who is right. If you want a hearing, we must receive your hearing request within 90 days of the mailing date on this notice. You do not need to return this form if you agree with the action. If someone else makes a written hearing request for you, it must include a written statement, signed by you, telling us that person is your representative. Only you can make a request by telephone. If you want information on free legal services but don?t know the number of your local legal aid office, you can call the Ohio State Legal Services Association, toll free, at 1-800-589-5888, for the local number. if you want a state hearing, check the appropriate boxes below, sign and date this form, and send it to the Ohio Department of Human Services, State Hearings, PO. Box 182825, Columbus, Ohio 43218?2825. I want a county conference and a state hearing on this action. a: I want a state hearing only. I want a hearing. Signature Date Telephone number Distribution: Original- Client Copy- Case Record P.R.C. NOTICE (010901) Cuyahoga Job and Family Services PRC Request Form Date Coach/Specialist Unique Phone Applicant Information Name Street Address City I State I Zip Code Phone Number Social Security Number Case Number of ParentsICaretakers [1 One parent household Two parent household Status Employed Unemployed Family Size Race of members in P.R.C. AIG: Race: Need [1 Immediate (must have approval) Review Committee ltem(s) requested for P.R.C. Funds Issuance Item Cost Code Type Vendor/Payee (if Order Check applicable) Purchase Order or Check to be: Picked Up Mailed out Stopped/Canceled (Order Only) Approval Signatures Date (Team Leader) (Team CoordinatorJReg. Mgr.) 3.R.C. Request Form (Effective 030100) P.R.C. Funds Type and Coding Charts (Revised 10/17) Help divert them from on-going assistance Help them in obtaining or retaining employment andlor training Help them with a need that affects the health and safety of the family cede .. . COde COde 01 ork Clothes 28 92 Electric 03 Safety/Work Shoes 38 43 Water 05 Clothing/Shoes - Adults 17 Ifs? I Phone 16 Clothinnghoes - Children 15 Work Supplies 53 Sewer 06 a .- I Background Check 54 PropaneIFuel Oil 09 Books 42 Fingerprinting 55 Misc. Utilities 07 Registration Fees 44 Employment Physical 56 I Testing Fees 45 Safety Glasses 57 Rent 12 License Fees 46 Misc. Work Expenses 35 Mortgage 22 Educational Supplies 47 Deposit 14 Tuition 48 Moving Expenses 40 Misc. Shelter 26 Emergency Shelter 13 Home Repair 39 Refrigerator 19 Washer 18 Dryer 95 Living Room Furniture 97 Car Payment 59 20 Car Lease 72 Bedroom Furniture 30 Car insurance 73 Furnace (purchase) 98 License Plates 74 CJFS PRC UTILITY ASSISTANCE REFERRAL Form is valid 30 days from the date of the Team Coordinator's signature Identifying Information; Applicant?s Name (First, Last) Case Number Social Security Number PR or Street Address City State Zip Household Size 0H Caseworker's Name Caseload ID Phone Number PRC Information: I hereby attest that the above-named client ls eligible for PRC benefits to pay utility costs. The maximum amount of PRC available to the client is WNW For APPROVED ITEMS: Electric Gas 1: Water Sewer Other Check this box If client was denied PRC For UNAPPROVED ITEMS: Electric i: Gas I I: Water Sewer 3' Other Supervisor?s Signature: Date: Housing Partners USE ONLY -- Please pay the following utility[ies] in the amount Specified. I: IIlumlnatingCoiOS) E:l Cleveland Public Power (03) Dominion (01} C: Columbia Gas (01) Water- (05) E: Sewer? we) I Olher- (or) CHN Representative?s Signature: Date: Return to CIFS Bene?ts Department of Payment Processing-1641 Payne Ave-Room sail-Cleveland, OH 44114 Distribution: Copy One: Case Record/OnBase Copy Three: Worker after payment Copy Two: CJFS Payment Processing Copy Four: CHN Case File Rev. 05012018 PRC Utility Assistance Referral Process-CHNr Housing Partners Iris strongly encouraged (baryon mil to rotate on appointment Appointments can be made at any time (24/7) By calling the appointmentiiufornntion line you can receive an appointment within 1-2 business days: P.R.C. Appointment line (216) 395-3006 Of?ce Hours: Monday-Friday, 8:30 am. - 5:00 pm Walk-ins are limited to customers whose utility is currently disconnected at the CHN Housing Partners (Asia Plaza) location from 8:30 am 3:30 p.111 Locations Fairfax Renaissance Famlcos Foundation CHN Housing Partners Metro West Development Corp. 1325 Ansel Road Asia Plaza 3167 Fulton Avenue 8111 Quincy Ave. Cleveland, Ohio 44106 2999 Payne Ave. Suite 303 Cleveland, Ohio 44104 Fax: 216-472-0979 Cleveland, Ohio 44114 Cleveland, Ohio 44102 Fax: 216-361-8653 Fax: 216-325-6541 Fax: 216-961-9387 PRC is limited to 1 use per utility each calendar year it is important to maintain your payments, otherwise you may be terminated from PIPP. A counselor from CHN Housing Partners will discuss all payment options. You must make your appointment with CHN Housing Partners within 30 days of being approved for PRC. if you fall to do this, you will have to re-appiy for PRC. THE FOLLOWING MUST BE BROUGHT TO YOUR UTILITY ASSISTANCE APPOINTMENT WITH CHN HOUSING PARTNERS 0 Your referral from Cuyahoga Job and Family Services 0 Valid Ohio Identi?cation [Driver?s License, State ID, Military iD, Passpon) 0 Proof of Social Security Number (required for all household members over the age of 2) 0 Can be an original copy 0 Letter from Social Security Administration verifying the application for number 0 A letter from a government agency containing the social security number 0 Lease Agreement or Landlord name and phone number if residence is all electric 0 Household Income 0 income veri?cation is required for all household members if paid bl-weeltly, you must bring your last 7 paystubs; if paid weekly, your last 13 pay stubs Ii receiving OWF, you must bring your award letter or print out stating benefit amount If you receive or SSA, you must bring your award letter stating your amount for the current year It you receive Child Support or Unemployment Benefits, you must bring a statement showing the benefits you have received in the current year 0 All Current Utility Bills 0 An ORIGINAL copy of the bill showing payment that was due within the last 30 days 0 A copy of the shutoff notice It applying for a new account 0 GAS Pending account number 0000 Eiectric Pendingaccountnumber letter #29 from the Illuminating company (can be faxed directly to CHN) Approvals Reason: Regulation: Denials Reason: Regulation: Reason: Regulation: Reason: Regulation: Reason: Regulation: Reason: Regulation: Reason: Regulation: Reason: Regulation: Reason: Regulation: P.R.C. Decision Reasons/Regulations ?Decision of Your Application for P.R.C. Benefits" form. You have met all eligibility requirements. You have met all eligibility requirements. Your current, documented need does not meet the definition of non-assistance. The benefits and services issued under the P.R.C. program must be consistent with the federal definition of ?non-assistance?. (Cuyahoga County P.R.C. Plan, Pg. 3) Your assistance group does not contain a minor child residing with you, nor are you currently pregnant. P.R.C. benefits and services are available to family assistance groups that contain a minor child or to pregnant individuals. (Cuyahoga County P.R.C. Plan, Pg. 4) Your assistance group contains no U.S. citizens or qualified aliens. To be eligible for P.R.C. benefits and/or services, at least one member of the assistance group must be citizens of the US or qualified aliens. (Cuyahoga County P.R.C. Plan, Pg. 4) You have not established that you are a resident of Cuyahoga County. P.R.C. benefits and/or services are available only to residents of Cuyahoga County.(Cuyahoga County P.R.C. Plan, Pg. 4) You have failed to verify that a specific change in circumstance has occurred leading to the current, documented need. The applicant must be able to verify that a proximate change in circumstance has led to the current, demonstrated need. (Cuyahoga County's P.R.C. Plan, Pg. 4) The services or items you have requested have been supplied by a community resource. A P.R.C. assistance group is required to apply for and utilize any program, benefits, or support system (up to a maximum of three which may reduce or eliminate the current, demonstrated need. (Cuyahoga County P.R.C. Plan, Pg. 5) You have failed to explore, apply for, and/or utilize community resources. A P.R.C. assistance group is required to apply for and utilize any program, benefits, or support system (up to a maximum of three which may reduce or eliminate the current, demonstrated need. (Cuyahoga County P.R.C. Plan, Pg. 5) You are a member of an OWF sanctioned assistance group and have not addressed your sanction appropriately with your OWF worker OWF sanctioned individuals are eligible for P.R.C. benefits and/or services during the sanction period as long as they have appropriately addressed the issue with the worker. (Cuyahoga County P.R.C. Plan, Pg. 5) Reason: Regulation: Reason: Regulation: Reason: Regulation: Reason: Regulation: Reason: Regulation: Reason: Regulation: Reason: Regulation: Reason: Regulation: You have not demonstrated how the issuance of P.R.C. benefits will assist you in complying with all terms of your Self-sufficiency Contracthlan. P.R.C. benefits issued to OWF sanctioned families must assist the AIG to comply with the provisions of the Self?sufficiency Contract/Plan. Failure of the P.R.C. applicant to demonstrate how the issuance will assist in achieving compliance or self-sufficiency will result in the denial of the application. (Cuyahoga County P.R.C. Plan, Pg. 5) You are ineligible to receive P.R.C. funds due to federal andlor state limitations on the use of P.R.C. funds. Federal and State law prohibit the issuance of P.R.C. benefits and/or services to families without a minor child, single individuals (unless pregnant), for medical services except pre- pregnancy planning, non-citizens of the US. or qualified aliens, fugitive felons, and families that have fraudulently received assistance under the OWF or P.R.C. programs. (Cuyahoga County P.R.C. Plan, Pg. 5 and 6) Your total verified, countable income of is in excess of the 200% of Federal Poverty Guidelines. The income level of the NC must be equal to or less than 200% of the Federal Poverty Level (excluding the income of a minor child and all applicable exclusions under the OWF and FS programs.) (Cuyahoga County P.R.C. Plan, Pg. 6) Your total, countable liquid assets of is in excess of the $1,000.00 limit and can meet the need. The P.R.C. applicant must utilize available income and resources in meeting the current, demonstrated need. P.R.C. applicants with liquid assets in excess of $1,000.00 will be required to use any funds over $1,000.00 as a co-payment to meet the current, demonstrated need.(Cuyahoga County P.R.C. Plan, Pg. 7) Your failure or refusal to provide verification required for determining your eligibility for the P.R.C. program. The P.R.C. must demonstrate and verify the need for financial assistance and/or services. (Cuyahoga County P.R.C. Plan, Pg. 7) You have failed to provide receipts for a previous P.R.C. benefits issued by a warrant. Failure by the applicant to provide receipts results in ineligibility for P.R.C. benefits until the receipts are received by the agency. (Cuyahoga County P.R.C. Plan, Pg. 7) You have failed to provide verification that you have paid the amount of money required to meet your current need over the amount of P.R.C to be issued. When the P.R.C. benefit to be issued is less than the amount required to meet the current, demonstrated need, the applicant must provide written verification that they have paid any amount required (over the amount ofthe P.R.C. payment) to meet the need, in full, prior to P.R.C. being issued. (Cuyahoga County P.R.C. Plan, Pg. 7) You have previously received the maximum amount allowed under the P.R.C. program within the current 12-month authorization period. P.R.C. applicants who meet all eligibility criteria may be eligible for up to $1,500.00 in a 12-month period. (Cuyahoga County P.R.C. Plan, Pg. 8) Reason: Regulation: Reason: Regulation: Reason: Regulation: Reason: Regulation: Reason: Regulation: Reason: Regulation: Reason: Regulation: Reason: Regulation: You have previously received the maximum amount allowed under the P.R.C. program within the current 12-month authorization period as a non-custodial parent. P.R.C. applicants who meet all eligibility criteria may be eligible for up to $750.00 in a 12- month period. (Cuyahoga County P.R.C. Plan, Pg. 8) You have previously received the maximum amount allowed under the P.R.C. program within the current 12-month P.R.C. authorization period as a non-custodial parent. P.R.C. applicants who meet all eligibility criteria may be eligible for up to $1,500.00 in a 12-month period. (Cuyahoga County P.R.C. Plan, Pg. 8) You do not have a current, established child support order. Non-custodial parents are eligible to receive P.R.C. benefits and/or services if there is a current child support order through the Office of Child Support Services (Cuyahoga County P.R.C. Plan, Pg. 8) You are not the non-custodial parent of a child who is in receipt of Ohio Works First cash assistance, Food Stamps, and/or Medicaid. Non-custodial parents of children who are in receipt of Ohio Works First cash assistance, food benefits, and/or Medicaid are eligible for P.R.C. direct services. (Cuyahoga County P.R.C. Plan, Pg. 8) You do not meet the definition of at least one of the eligible categories of applicants for the P.R.C. program. In addition to meeting all other P.R.C, criteria an applicant must meet the criteria in at least one of the eligible categories to be eligible to receive direct services specific to a category of eligibility. (Cuyahoga County P.R.C. Plan, Pg. 8-10) Your current, documented need can be met through the use of another federal or state program. Applicants may not utilize P.R.C. benefits to meet a current, demonstrated need that can be met through the use of another federal-or state program. (Cuyahoga County?s P.R.C. Plan, Pg. 8-10) You may not utilize P.R.C. to directly pay court-ordered child support payments Applicants may not utilize P.R.C. benefits to directly pay court?ordered child support payments. (Cuyahoga County?s P.R.C. Plan, Pg. 11) Your current, documented need is the result of a violation of federal, state, or local laws. Applicants may not utilize P.R.C. benefits to pay any costs associated with the violation of federal, state, or local laws. (Cuyahoga County?s P.R.C. Plan, Pg. 11) Reason: Regulation: Reason: Regulation: Reason: Regulation: Reason: Regulation: Reason: Regulation: Reason: Regulation: Reason: Regulation: Reason: Regulation: Reason: Regulation: Reason: Regulation: Your current, documented need is for a cost associated with the provision of child care. P.R.C. benefits cannot be used to pay fees associated with child care including the child care co?payment. Reason. (Cuyahoga County?s P.R.C. Plan, Pg. 11) You do not have a court-ordered eviction notice issued by your landlord nor a "Notice of Condemnation". P.R.C. benefits for rental assistance and/or security deposits are available only when a court-ordered eviction notice has been issued by a landlord or a "Notice of Condemnation? has been issued. (Cuyahoga County?s P.R.C. Plan, Pg. 12-13) You have already received a P.R.C. payment for rent and/or security deposit once during the current 12?month authorization period. An applicant may receive P.R.C. for rent and/or security deposit assistance once in the 12-month authorization period. (Cuyahoga County P.R.C. Plan, Pg. 12-13) You have not demonstrated how you can pay your rent on an on-going basis. The applicant must demonstrate that they are able to pay their rent on an on?going basis prior to the issuance of P.R.C. (Cuyahoga County P.R.C. Plan, Pg. 12- 13) Your current, documented need exceeds the established limits for furniture and app?ances Furniture items (including washers/dryers) cannot exceed $400.00 and can only be issued once in a five-year period. (Cuyahoga County?s P.R.C. Plan, Pg. 13) Your current, documented need is considered an entertainment item. Furniture items cannot include entertainment items such as radios, televisions, nor entertainment centers. (Cuyahoga County?s P.R.C. Plan, Pg. 13) Your current, demonstrated need is not integral to your employment. Washers and/ or dryers can only be issued when they are integral to the applicant's employment. (Cuyahoga County's P.R.C. Plan, Pg. 13) You have previously received the maximum amount allowed under the P.R.C. program for utility payments within the current 12-month P.R.C. eligibility period. P.R.C. applicants who meet all eligibility criteria may be eligible for up to $750.00 in theiZ-month authorization period. (Cuyahoga County P.R.C. Plan, Pg. 13-14) You do not have a shut-off notice issued from the utility company. The applicant must have a "shut-oft? notice from the utility company for a utility bill in their name. (Cuyahoga County P.R.C. Plan, Pg. 13-14) You have failed to enroll in the Percentage of income Program (PIP). The applicant must apply for the Percentage of Income program prior to the issuance of P.R.C. (Cuyahoga County P.R.C. Plan, Pg.13-14) Reason: Regulation: Reason: Regulation: Reason: Regulation: Reason: Regulation: Reason: Regulation: Reason: Regulation: Reason: Regulation: Reason: Regulation: Reason: Regulation: Reason: Regulation: You have failed to participate in the (HEAP). The applicant must utilize HEAP, when available, prior to the issuance of P.R.C. (Cuyahoga County P.R.C. Plan, Pg. 13?14) You have failed to meet with the Cleveland Housing Network. The applicant must be referred to the Cleveland Housing Network prior to the issuance of P.R.C. (Cuyahoga County P.R.C. Plan, Pg. 13-14) You have not been enrolled in your program for the required time period Applicant must be enrolled for minimum number of days based on length of training program (Cuyahoga County P.R.C. Plan, Pg. 14) You have previously received the maximum amount allowed under the P.R.C. program for education-related equipment costs within the current 12-month P.R.C. eligibility period. Education?related equipment costs are limited to no more than $500.00 in the 12-month authorization period. (Cuyahoga County P.R.C. Plan, Pg. 13) You have already used the maximum of amount of P.R.C. for the issuance of a stove during the current 12-month authorization period. P.R.C. for the purchase of a stove is limited to no more than $200.00. (Cuyahoga County P.R.C. Plan, Pg. 15) You have been issued P.R.C. for a stove within the last five years. P.R.C. for the purchase of a stove is limited to no more than once in a five-year period. (Cuyahoga County P.R.C. Plan, Pg. ?15) You have already used the maximum of amount of P.R.C. for the issuance of a refrigerator during the current 12-month authorization period. P.R.C. for the purchase of a refrigerator is limited to no more than $200.00. (Cuyahoga County P.R.C. Plan, Pg. 15) You have been issued P.R.C. for the purchase of a refrigerator within the last five years. P.R.C. for the purchase of a refrigerator is limited to no more than once in a five- year period. (Cuyahoga County P.R.C. Plan, Pg. 15) You have already used the maximum of amount of P.R.C. for the issuance of a bed per child during the current 12-month authorization period. P.R.C. for the purchase of a bed is limited to no more than $250.00. (Cuyahoga County P.R.C. Plan, Pg. 15) You have been issued P.R.C. for the purchase of a bed for the same child within the last five years. P.R.C. for the purchase of a bed for the same child is limited to no more than once in a five?year period. (Cuyahoga County P.R.C. Plan, Pg. 15) Reason: Regulation: Reason: Regulation: Reason: Regulation: Reason: Regulation: Reason: Regulation: ?Note? You have already used the maximum of amount of P.R.C. for the issuance of children's clothing (for the same child) during the current 12-month authorization pe?od. P.R.C. for the purchase of a bed is limited to no more than $150.00. (Cuyahoga County P.R.C. Plan, Pg. 15-16) Your request for vehicle repair does not meet P.R.C. program established criteria because . The applicant must verify: that the vehicle has been tilted in their name for at least thirty days, that the repair does not exceed the value of the vehicle, the repair must be completed by a certified mechanic, the facility must agree to accept a voucher, the repair must make the vehicle sound, they currently have valid insurance, that all P.R.C. eligibility has been met. (Cuyahoga County's P.R.C. Plan, Pg. 16) You cannot use P.R.C. funds to help pay for any item requiring additional financing. P.R.C. cannot be used for any items that require additional financing over the P.R.C. issuance to meet the current, demonstrated need. (Cuyahoga County P.R.C. Plan, Pg. 17) The specific type of need you are requesting has already been met within the last four months. P.R.C. benefits and/or services may be issued for a specific type of need to non?employed once in a four-month period. (Cuyahoga County's P.R.C. Plan, Pg. 17) The specific type of need you are requesting has been issued within the last one- month period. that contain employed individuals may receive P.R.C. benefits and/or services for a specific type of need once in a one-month period. (Cuyahoga County?s P.R.C. Plan, Pg. 17) This is list is not intended to be all-inclusive. If a reason for denial can be substantiated by any of the P.R.C. program policy outlined in P.R.C. Program Manual, but does not appear on this list, it may be included on the ?Notice of Decision of Your Application for P.R.C.