N.H. Code Admin. R. Gcd 303.04 - Application Form
An applicant for participation in TEAP shall provide the following information on the application form:
(a) The applicant's name;
(b) The applicant's residential and
e-mail addresses;
(c) The
numbers by which the applicant can be reached by telephone, TTYor
fax,oremail;
(d) By checking one of 2 boxes
labeled "yes" and "no", indicate whether:
(1) The applicant has a disability
that makes use of a standard telephone difficult;
(2) The applicant has attached to
the application the certification of disability described in
Gcd 303.06;
(3) The applicant lives in New
Hampshire;
(4) The
applicant at the time of application has telephone service or, if
not, is able to obtain telephone service;
(5) The applicant receives or is
eligible for any of the following programs:
a.Senior companion
program;
b.Aid to the
needy blind (ANB);
c.Food
stamp program;
d.State-funded childcare;
e.Meals on wheels;
f.Elderly nutrition
program;
g.Aid to the
permanently and totally disabled (APTD);
h.Medical assistance
(Medicaid);
i.State fuel
assistance;
j.Temporary
Assistance to Needy Families (TANF);
k.Headstart;
l.Women, Infants and Children
Program (WIC); and
(6) The applicant meets the income
eligibility standard for full financial assistance or alternatively
the applicant is over the income eligibility limit for full financial
assistance and agrees to reimburse the program for 50 per cent of the
cost of equipment approved and ordered.
Notes
#7636, eff 1-30-02, EXPIRED: 1-30-10
New. #10128, INTERIM, eff 5-16-12, EXPIRED: 11-13-12
New. #10340, eff 5-17-13
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.