Instructions: If TANF or Medical assistance is being requested for any child under the age of 19 please answer “Yes” and complete the rest of the tab.

Instructions: If a child on the case is deprived as the result of the absence of at least one of his or her legal parents, click “Yes” to this box. Then click on the “Absent Parent Info” window and complete that tab.

See TANF: Continued absence of the natural or adoptive parent(s) from the home 340:10-10-4

See Medical: Determining categorical relationship to children and parent and caretaker relative groups 317:35-5-7

If absence exists for any child receiving TANF, Medical, or Child Care you must complete the Absent Parent Information for that child.

Instructions: If a child on the case is deprived as the result of the incapacity of at least one of his or her legal parents, click “Yes” to this box.

If a child is deprived of support due to the incapacity or disability of a parent, both parents must be in the home and at least one is incapacitated or disabled. Discuss the level of incapacity with the client. Gather enough information to complete form ABCDM-80-D. Explain the Medical Social Summary and the referral to OHCA. If the parent has been determined disabled by SSA, eligibility for SSP must be explored.

See TANF: Physical or mental incapacity of the natural or adoptive parent 340:10-10-2.

See Medical: Determining categorical relationship to children and parent and caretaker relative groups 317:35-5-7.

Instructions: List the children of the parent who is incapacitated or disabled.

Instructions: List the name of the parent who is incapacitated or disabled.

Instructions: If a child on the case is deprived as a result of the death of at least one of his or her legal parents, click “Yes” to this box.

If a child is deprived of support due to the death of a parent, there will only be one parent in the home.

If an application for SSA benefits has not been made, referral to SSA may be needed.

If the situation is questionable, a copy of the death certificate or a published notice of death may be requested.

See TANF: Deprivation of parent support or care by a natural or adoptive parent 340:10-10-1.

See Medical: Determining categorical relationship to children and parent and caretaker relative groups 317:35-5-7.

Instructions: List the children of the parent who is deceased.

Instructions: List the name of the parent who is deceased.

Instructions: List the Social Security Number of the parent who is deceased. The child may be eligible to receive survivor benefits under this number if the deceased parent had a work history.

Instructions: List the date of death of the parent who is deceased.

Instructions: If a child on the case is deprived as the result of the unemployment of at least one of his or her legal parents, click “Yes” to this box.

If a child is deprived of support due to the unemployment of a parent, the unemployed parent must reside in the home. You must establish the Principal Wage Earner (PWE). Use forms FSS-UP-1, FSS-UP-2, and FSS-UP-3.

See TANF: Unemployed parent 340:10-10-3.

See Medical: Determining categorical relationship to children and parent and caretaker relative groups 317:35-5-7.

Instructions: List the children of the parent who is unemployed.

Instructions: List the name of the parent is unemployed.