What forms are required for a TANF certification with parent included in benefit?

1. Request for Benefits, 08MP001E (PS-1), Paper applicants only.

2. Eligibility Information for Benefits, 08MP002E (FSS-1), Paper applicants only.
3. Rights, Responsibilities, and Signature for Benefits, 08MP003E (FSS-1-B), Paper applicants only.

Note: With two-parent households each parent must sign the FSS-1-B.

4. Effect of Lump Sum Payments on TANF benefits, 08TA006E (FSS-C-4), Paper applicants only.
5. Citizenship Affidavit, 08MP005E (when birth certificate is not provided).
6. Declaration of Citizenship Status, 08MP022E (for non-US citizens).
7. Out of State Inquiry, 08AD080E (ADM-80)

Note: if client declares they have lived in any other state since birth of oldest child.

8. School Attendance Verification, 08AD010E (ADM-96).
9. Immunization Certificate of Exemption, 08TA017E (FSS-TANF-1), if needed.
10. Deprivation

• • Deprivation based on Absence
    • Non-Custodial Parent Letter, 08AD008E (ADM-95) if the address of noncustodial parent is available.
    • Good Cause Report, 08TA009E (C-15) when good cause is requested.
    • Child Support Services and Responsibilities, (C-16) given to client. Paper applicants only.
    • Cooperation Agreement and Request for Good Cause, 08TA012E (C-9) Paper applicants only.
    • Non-Custodial Parent (NCP) Information Sheet, 08TA001E (FSS-AP-1A) Paper applicants only.

Note: 08TA009E (C-15) is the form that will be emailed to AFS.TANF@OKDHS.ORG by a supervisor. All other child support forms are to be imaged into the case record.

• • Deprivation based on Unemployed Parent
    • Worksheet to Determine Principal Wage Earner, 08TA002E (FSS-UP-1)
    • Worksheet to Determine Work History, 08TA003E (FSS-UP-2)
    • Worksheet to Determine Deemed Unemployment Insurance Benefits (UIB) Eligibility, 08TA004E (FSS-UP-3)
  • Deprivation based on Incapacity
    • Work Tolerance Report, 08TW027E (TW-27)
    • Authorization to Disclose Protected Health Information (PHI), 13HI003E (HIPPA-3)

11. TANF Work and Personal Responsibility Agreement, 08TW002E (TW-2)
12. Interagency Referral and Information, 08TW003E (TW-3)

What forms are required for a Child-Only TANF certification?

1. Request for Benefits (PS-1), Paper applicants only.
2. Eligibility Information for Benefits, 08MP002E (FSS-1), Paper applicants only.
3. Rights, Responsibilities, and Signature for Benefits, 08MP003E (FSS-1-B), Paper applicants only.
4. Effect of Lump Sum Payments on TANF benefits, 08TA006E (FSS-C-4), Paper applicants only.
5. Child Support Forms (for all non-custodial parents):
   • Non-Custodial Parent Letter, 08AD008E (ADM-95) if the address of noncustodial parent is available.
   • Good Cause Report, 08TA009E (C-15) when good cause is requested.
   • Child Support Services and Responsibilities, (C-16) given to client. Paper applicants only.
   • Cooperation Agreement and Request for Good Cause, 08TA012E (C-9), Paper applicants only.
   • Non-Custodial Parent (NCP) Information Sheet, 08TA001E (FSS-AP-1A) Paper applicants only.

Note: 08TA009E (C-15) is the only form that will be emailed to AFS.TANF@OKDHS.ORG by a supervisor. All other child support forms are to be imaged into the case record.

6. School Attendance Verification, 08AD010E (ADM-96).
7. Immunization Certificate of Exemption, 08TA017E (FSS-TANF-1), if needed.