VETERANS' RELIEF FUND Policy & Procedure 950

Similar documents
VETERANS' ASSISTANCE. Policy 950 i

Indiana Energy Assistance Program Application Part 1. Personal Information

Henry County Veteran Affairs General Assistance Policy Ordinance Revised 08/02/2004

St. Vincent Apartments 1521 Las Vegas Blvd. North Las Vegas, NV 89101

WYOMING LIEAP AND WEATHERIZATION APPLICATION FORM

March 31, 2006 APD OP SUPPORTED LIVING PROVISION OF IN-HOME SUBSIDIES FOR PERSONS IN SUPPORTED LIVING ARRANGEMENTS

SUPPORTED LIVING PROVISION OF IN-HOME SUBSIDIES FOR PERSONS IN SUPPORTED LIVING ARRANGEMENTS

SUBCHAPTER 11. CHARITY CARE

APPLICATION for If you have questions, please refer to the instructions page. Return ALL pages 1 through 6

Weatherization Assistance Program

This is an application to have your ENROLLMENT FEES WAIVED. If you need money to help with books, supplies,

This is an application to have your ENROLLMENT FEES WAIVED. If you need money to help with books, supplies,

SPRING BRANCH COMMUNITY HEALTH CENTER

CHECKLIST OF MANDATORY DOCUMENTS FOR HEAP

California Community Colleges California College Promise Grant Application Formerly known as the Board of Governors Fee Waiver

CATHERINE FUND FINANCIAL AID APPLICATION March 2016

New Hampshire State Office of Veterans Services NH PROPERTY TAX CREDIT TRAINING

RNDC does not discriminate on the basis of age, race, sex, creed, or disability. Equal Opportunity Lender

HOUSTON HOUSING AUTHORITY Public Housing Grievance Policy

LIHEAP and Weatherization Application and Required Documentation Check List

6. APPEAL FORM: Please sign and return the office copy of the Appeal Procedure form, and retain the client copy for your records.

HOME ENERGY ASSISTANCE/UNIVERSAL SERVICE FUND (USF) AND WEATHERIZATION PROGRAM APPLICATION

APPLICATION FOR EMPLOYMENT The City of DeBary is an Equal Employment Opportunity Employer

WISCONSIN SURVIVING SPOUSES PROPERTY TAX CREDIT. Information, Instructions, and Request Forms. Current as of March 2015

CASSELBERRY NEIGHBORHOOD IMPROVEMENT GRANT PROGRAM FY APPLICATION

THE CONFEDERATED TRIBES OF THE COLVILLE RESERVATION Health and Human Services Department Social Services Program

MILITARY CIVIL RELIEF ACT (excerpts) 51 Pa.C.S et seq. (see section 7315 for lease termination provisions) TABLE OF CONTENTS

COMMUNITY ACTION AGENCY OF DELAWARE COUNTY, INC. WEATHERIZATION. 94 Jansen Avenue Essington, PA Phone: Fax:

Candidates failing to include ALL required documentation will be disqualified.

DAILY LIVING NEEDS PROGRAM GUIDELINES AND APPLICATION

Once the application and all of the required information has been gathered, send the documents and the application to the Bloomington SCCAP office.

Wayzata Fire Department 600 East Rice Street Wayzata, Minnesota (952)

Citrus County Tax Collector s Office Application for Employment

GUIDE TO SERVICES Service Coordination

Employment, Training, and Support Services Application

CITY OF LAKE MARY 100 N. COUNTRY CLUB RD MAILING ADDRESS: P. O. BOX LAKE MARY, FL PHONE

Financial Assistance Finance Official (Rev: 4)

Skagit Regional Health Financial Assistance/Sliding Fee Scale Business Office - Hospital Official (Rev: 6)

Rice County HRA Bridges Application

SPECIAL POWER OF ATTORNEY

Veterans Assistance Eligibility Criteria

Aberdeen School District No North G St. Aberdeen, WA REQUEST FOR PROPOSALS 21 ST CENTURY GRANT PROGRAM EVALUATOR

Grand Prairie Fire Department Applicant Identification Form

Application Packet for 2017 Summer Youth Employment Program

MARCH AGES:

RECOVERY KENTUCKY ADMINISTRATIVE MANUAL INTRODUCTION

Rehabilitation Grant Program (RGP) Information & Application

RESIDENCY CLASSIFICATION MILITARY ACTIVE DUTY PETITION

Y.ukon Business Nomi nee Policy

YATES COUNTY PERSONNEL DEPARTMENT

South Carolina Radiation Quality Standards Association Code of Ethics

CITY OF LA PUENTE SCHOLARSHIP PROGRAM GUIDELINES FOR ACADEMIC YEAR WHO SHOULD APPLY

Neighborhood Services 900 W. Gentry Parkway Tyler, Tx Office (903) Fax (903) FAMILY SELF SUFFICIENCY ASSESSMENT QUESTIONNAIRE

PLEASE TYPE OR PRINT CLEARLY USING A PEN. Today s Date:

Home Energy Saving (HES) scheme - Homeowner Application Form Version 10.0

Chapter 5 BRIEFINGS AND VOUCHER ISSUANCE

Northern Sonoma County Air Pollution Control District Burn Clean! Wood Appliance Replacement Program

Home Energy Assistance Universal Service Fund Weatherization Assistance

Chapter 14 COMPLAINTS AND GRIEVANCES. [24 CFR Part 966 Subpart B]

xx R.E.T.I. to Start, Grow & Succeed in Business!

GUIDELINES FOR BUSINESS IMPROVEMENT GRANT PROGRAM BY THE COLUMBUS COMMUNITY & INDUSTRIAL DEVELOPMENT CORPORATION

Your application will be considered complete once you have included the following documents with your campus apartment application.

ASHBY HOUSE DIGNITY COMMONS HOUSE OF DIGNITY

Chapter 5 BRIEFINGS AND VOUCHER ISSUANCE PART I: BRIEFINGS AND FAMILY OBLIGATIONS

SB 420 Medical Marijuana Identification Card MMIC Program

APPLICATION FOR EMPLOYMENT

Byrd Barr Place Energy Assistance Program LIHEAP:

HOUSTON HOUSING AUTHORITY. Public Housing Grievance Policy

Military Reference Guide

CHAPTER Committee Substitute for House Bill No. 29

Application for In-State Tuition Based Upon Military Service Exceptions

Transmittal for Handbook No: REV-1,CHG-4 Issued:

PHOTO ID: A copy of your driver s license or other government-issued photo ID must be submitted. It must include your name and photograph.

Home Energy Saving (HES) scheme - Homeowner Application Form Version 1.0

Last Name: First Name: Middle Name: Street Address: City: State: Zip Code: Home Phone: Work Phone: Cell Phone: May We Call You at Work?

PRIVATIZED HOUSING REFERRAL FORM

Guide to Acceptable Documentation for the National Verifier. National Verifier Acceptable Documentation Guidelines

Paramedic (Entry Level) CAREERS Application & Public Safety Entry Registration System (PERS) Frequently Asked Questions (FAQs)

Application Processing Procedures and Resident Selection Criteria

LIBRARY COOPERATIVE GRANT AGREEMENT BETWEEN THE STATE OF FLORIDA, DEPARTMENT OF STATE AND [Governing Body] for and on behalf of [grantee]

The California End of Life Option Act (Patient s Request for Medical Aid-in-Dying)

Amended Guidelines for the Small Firm Assistance Program

Scott Ellis CLERK OF THE CIRCUIT AND COUNTY COURTS BREVARD COUNTY, FLORIDA

What to do when a Veteran Passes Away

EMPLOYMENT PRE-SCREEN QUESTIONNAIRE

Private Investigator and/or Security Guard Qualifying Agent Application

Application form and lodgement guide

RECEIPT OF NOTICE OF PRIVACY PRACTICES WRITTEN ACKNOWLEDGEMENT FORM. I,, have received a copy of Dr. Andy Hand s Notice of Privacy Practice.

CENTRAL GEORGIA ELECTRIC MEMBERSHIP CORPORATION EMPLOYMENT APPLICATION

Matlacha/Pine Island Fire Control District 5700 Pine Island Road Bokeelia, FL APPLICATION FOR EMPLOYMENT

76th OREGON LEGISLATIVE ASSEMBLY Regular Session. Enrolled. Senate Bill 1563

AGREEMENT BETWEEN: LA CLÍNICA DE LA RAZA, INC. AND MOUNT DIABLO UNIFIED SCHOOL DISTRICT

Industrial Optimization Program: Feasibility Study

Application Requirements to be considered for Approval:

O P E R A T I O N S M A N U A L

COMMUNITY HOWARD REGIONAL HEALTH KOKOMO, INDIANA. Medical Staff Policy POLICY #4. APPOINTMENT, REAPPOINTMENT AND CREDENTIALING POLICY

EXPLANATORY MEMO HOUSING ADAPTATION GRANT FOR PEOPLE WITH A DISABILITY CHECKLIST

PATIENT INFORMATION Please Print

GENERAL APPLICATION FOR EMPLOYMENT Human Resources City of New Smyrna Beach 210 Sams Avenue New Smyrna Beach, Florida 32168

DIVISION OF PROFESSIONAL LICENSURE BOARD OF CERTIFICATION OF OPERATORS OF DRINKING WATER SUPPLY FACILITIES

Transcription:

VETERANS' RELIEF FUND Policy & Procedure 950 Table of Contents.1 Purpose... 1 1.1 Source of Funds... 1 1.2 Policy... 1 1.3 Verbal and/or Physical Abuse... 1.2 Eligibility... 2 2.1 Service Requirements... 2 2.2 Types of Discharge Character of Service... 2 2.3 State Residency... 2 2.4 County Residency... 2.3 Required Documentation... 3 3.1 Discharge... 3 3.2 Residency... 3 3.3 Family Dependents... 3 3.4 Income Verification... 3 3.5 Income Limits/Guidelines... 4 3.6 Rent or Lease Agreement... 4 3.7 Disabled Applicants... 4.4 Application and Assistance Process... 5 Policy 950 Page i

4.1 Delegation of Veterans' Coordinator's Tasks... 5 4.2 Appointment Procedures... 5 4.3 Application for Assistance... 5 4.4 Voucher Assistance Procedures... 6 4.5 Voucher Processing... 6 4.6 Denial of Assistance... 6 4.6.1 Divorce Remarried Spouse of Widow... 7 4.6.2 Fraud and/or Abuse... 7.5 Denial of Service Appeal Process... 7 5.1 Complaints or Appeals... 7 5.2 Non-Appealable Issues... 7 5.3 Appeal Process Procedures... 7 5.4 Further Appeal (Due Process)... 8.6 Authorized Use of Funds... 8 6.1 Assistance Defined... 8 6.2 Eligible Items/Services for Assistance... 8 6.3 Primary Service Location... 9 6.4 Schedule of Assistance... 9.7 Veterans' Coordinator Position and Duties... 9 7.1 Defined... 9 Policy 950 Page ii

7.2 Veterans' Coordinator's Decisions and Actions... 9 7.3 Relationship with Veterans' Organizations...10 Appendix A Forms... 11-19 Appendix B Schedule of Assistance... 20-21 Policy 950 Page iii

VETERANS' RELIEF FUND.1 PURPOSE To provide emergency financial assistance to indigent/low income 1 eligible veterans and certain eligible dependents, in accordance with RCWs 73.08.010 through 73.08.080. 1.1 Source of Funds Funding for the Veterans Relief Fund is provided in accordance with RCW 73.08.080 and applicable County ordinances. The Veterans Relief Fund is a Special Revenue Fund budgeted and approved by the Clallam County Board of Commissioners. Responsibility for uses and expenditures from the fund are the responsibility of the Board of Commissioners. As such, the County maintains final approval and/or denial authority on all claims and expenditures. 1.2 Policy Through the administration of said funds, the Clallam County Veterans Relief Fund intends to provide timely services to eligible veterans and certain dependents. The purpose of these policies are to limit organizational and personal conflict of interest and to provide, to the maximum extent possible, fair and equal treatment to all applicants requesting assistance through this program. The basis for any assistance request must be an emergency. Assistance may be provided for reasonable, basic, subsistence needs. 1.3 Verbal and/or Physical Abuse Policy The Clallam County Veterans Relief Fund has a ZERO TOLERANCE POLICY of verbal or other forms of abuse directed towards veterans, the Veterans Coordinator, volunteers, or any other staff. Any form of verbal or physical abuse towards any staff or volunteer may be deemed sufficient cause to deny service. The client will be told to leave the office immediately. If the Veterans Coordinator (or designated officer) deems the abuse to be severe, the client may be denied service from the Veterans Relief Fund for a period of time deemed appropriate by the decision of the Veterans Coordinator (or designated officer) and the Veterans Affairs Advisory Committee for up to five (5) years. Anyone under the influence of alcohol and/or any other drugs will be denied service and told to leave the premises. The Veteran Coordinator s decision is final. 1 As defined in RCW 10.101.010 Policy 950 Page 1

.2 ELIGIBILITY 2.1 Service Requirements To be eligible for assistance, veterans must, at the time they seek assistance, meet one of the following service requirements as defined in RCW 41.04.005, revised June 13, 2002: Veteran includes every person, who... has received an honorable discharge or received a discharge for medical reasons with an honorable record, where applicable, and who has served in at least one of the following capacities: As a member in any branch of the armed forces of the United States, including the National Guard and Armed Forces Reserves, and has fulfilled his or her initial military service obligation; As a member of the women s Air Forces Service Pilots; As a member of the Armed Forces Reserves, National Guard, or Coast Guard, and has been called into federal service by a presidential select reserve call up for at least 180 cumulative days; As a civil service crewmember with service aboard a U.S. Army transport service or U.S. Naval transportation service vessel in oceangoing service from December 7, 1941 through December 31, 1946; or As a member of the Philippine Armed Forces/Scouts during the period of armed conflict from December 7, 1941, through August 15, 1945. 2.2 Types of Discharge Character of Service - Veterans qualifying under Section 2.1 above, must have received a discharge showing their character of service as honorable, under honorable conditions, or a medical discharge under honorable conditions. 2.3 State Residency In accordance with RCW 73.08.010, veterans, or families of deceased veterans must have been residents of the state of Washington, for at least twelve (12) consecutive months preceding the date of application for assistance. 2.4 County Residency Applicants must reside in Clallam County or must be moving into Clallam County at the date of application. Proof of residency may be required by the Veterans Coordinator (or designated officer). Policy 950 Page 2

.3 REQUIRED DOCUMENTATION 3.1 Discharge For Veterans of WW II, a discharge certificate is required. For all other periods of service after WW II, the DD form 214 (DD-214) is required and will be the only acceptable documentation of veteran status. Under certain emergent situations/conditions, the Veterans' Coordinator (or designated officer) may, at his/her discretion, accept a VA Statement of Service, (SOS), provided the information relevant to eligibility is complete. (If the veteran s branch, dates or character of service are not on the SOS, it will not be accepted.) A complete VA SOS will be accepted one time only for a first time assistance request. The Veterans Coordinator (or designated officer) will instruct, and help the veteran if necessary, to complete the appropriate form (SF-180) for the veteran to send to NPRC for a certified copy of their DD-214. Any subsequent requests for assistance will require the veteran to have a copy of his/her DD-214. All veterans will be encouraged to record their original or certified copy of their discharge with the County Auditor s Office. This service is free in accordance with RCW 73.04.030. Questionable Copies of Discharge - Any copy of a discharge that appears to have been altered in any way, or is deemed questionable by the Veterans' Coordinator (or designated officer) will not be accepted. The Veterans Coordinator (or designated officer) has the authority and responsibility to demand a certified copy of the document in question before any assistance will be provided to any applicant. 3.2 Residency Residency may be documented by: Washington state driver s license, state I.D. card, rent/lease agreement(s), utility bill(s) or other form of verifiable documentation deemed acceptable by the Veterans Coordinator (designated officer). In any case, documents must prove 12-month residency. 3.3 Family Dependents Documents must be provided to verify marriage, birth of children 2 or other form of dependency, and death. (Marriage certificate, birth certificate, death certificate, etc.) 3.4 Income Verification All household income and source(s) must be documented. Acceptable documents may be 2 Children who have reached the age of majority, (18), are not considered dependents, unless they are severely disabled and dependent on parents for basic survival needs. Policy 950 Page 3

pay stubs, VA Disability/Pension award letters, Department of Social & Health Services documents, Social Security grant/award letters, Labor & Industry payment letters, unemployment check stubs/award notices, or any other documents deemed necessary by the Veterans Coordinator (or designated officer). If an applicant claims they have no income in the recent past or currently have no income, the applicant will be required to complete an Eligibility Income Verification Checklist and/or a No or low income statement. 3 Self-employed applicants must bring valid income accounting records, business tax I.D. number, business license, (if applicable), or other documentation deemed acceptable by the Veterans Coordinator (or designated officer). Unemployed Veterans - Work Search Requirement - Unemployed veterans who are able to work must have made, and be able to prove, a minimum of four (4) in-person contacts for work, per month, for each month they have been unemployed. The Veterans Coordinator (or designated official) will verify these contacts. Veterans must provide the name of the employer contacted, name of person they spoke to and phone number for each contact. The applicant must be registered with the Veterans Job Service Section at a local unemployment office and have applied for unemployment compensation. Unemployment compensation check stub or denial notice is required. 3.5 Income Limits/Guidelines All household income must be at or below the 125 percent level of the Federal Poverty Level Income Guidelines established and published by the Department of Social & Health Services. Said guidelines are adjusted and revised annually. The guidelines published for the current year will be used. 3.6 Rent or Lease Agreement The agreement 4 must have the landlord, owner or legal agent of owner s name, address and phone number on the document, the rental address and monthly rent amount. This agreement must be dated and signed by the renter and landlord or legal agent. Sublet agreements written by a shared roommate will not be accepted. The applicant s name must be on the legal agreement between the landlord and primary renter. 3.7 Disabled Applicants If applicant is disabled to the degree that they are unable to do any kind of work, appropriate disability documentation will be required. A Veteran s Administration, Social Security, or Labor & Industry document and/or letter from physician will be acceptable. 3 See Appendix A for sample of form(s). 4 See Appendix A for sample of form and information required. Policy 950 Page 4

.4 APPLICATION AND ASSISTANCE PROCESS 4.1 Delegation of Veterans Coordinator's Tasks The Veterans Coordinator (or designated official) shall be a County employee designated by the Board of Clallam County Commissioners. The Veterans Coordinator (or designated official) is responsible to determine and document eligibility, approve or deny claims, process vouchers, ensure payment, provide for records of all claims, and provide reports of payments of claims. All, or part, of the Veterans' Coordinator s duties may be delegated, in writing, to a designated official of a veteran s organization. Veterans may initiate claims by contacting the County's Veterans Coordinator (or designated official) or designated officers of any authorized Veterans Organization's Post/Chapter within Clallam County that has, on file with the County Auditor and County Commissioners' Office, a current Notice of Intention to Furnish Relief. Tentative approval of claims may be made by the Commander and Quartermaster, Commander and Adjutant, or Commander and Service Officer of any authorized Post/Chapter, or by officers of a Veterans Association that has a written agreement to process and tentatively approve claims collectively. Final approval of claims is the responsibility of the County Veterans Coordinator (or designated official) based upon submission of complete and accurate claims and documentation. Incomplete or undocumented claims may be returned to the Post/Chapter and are a sufficient reason for denial of claim. 4.2 Appointment Procedures All applicants will be pre-screened for basic eligibility by Service Officers of local Veterans' Relief Association Members or by walk-in contact at the Clallam County Commissioners Office at 223 East 4 th Street, Port Angeles, WA, 98362, 360.417.2383. Applicants will be scheduled for an appointment at the time of pre-screening. Applicants will be seen by appointment only, unless other arrangements are made with the Veterans Coordinator (or designated official). Emergency requests for assistance will be evaluated by the Veterans Coordinator (or designated official) on a case-by-case basis. 4.3 Application For Assistance Request for assistance is made by completion of a Clallam County Application for Assistance form. 5 The application will be completed at the time of appointment. Signature of affirmation and verification of information authorization is mandatory. Refusal to sign will preclude applicant from receiving assistance. No subsequent requests for assistance will be accepted within twelve (12) months from the 5 See Appendix A for copy of form. Policy 950 Page 5

date of last assistance. There is no entitlement to assistance every 12 months. All applications will be evaluated on the merits of the request. All required documentation must be brought in at the time of appointment. Failure to bring all required documentation will result in having the veteran s appointment rescheduled, at which time all documents must be brought in. If a veteran is more than ten minutes late for his/her appointment, it may be rescheduled at a different date and/or time. 4.4 Voucher Assistance Procedures After all documentation for eligibility has been verified and accepted by the Veterans Coordinator (or designated official), a voucher(s) may be issued for the emergency assistance requested. Outreach assistance may be provided to disable and/or housebound veterans or certain eligible dependents. 4.5 Voucher Processing Upon receipt of a properly completed voucher with proper invoice, bill or landlord statement attached, the Veterans Coordinator (or designated official) will verify proper completion and approve the voucher for payment. The voucher will then be processed by Clallam County Accounts Payable Department for payment. No warrant will be made payable to the veteran, or veteran s spouse 6, only to the vendor or service provider listed on the original voucher. Incomplete, incorrectly completed vouchers received for payment, without necessary bill(s) or landlord statement attached, will be returned to the vendor or Post/Chapter for proper completion before processing for payment. 4.6 Denial of Assistance The Veteran s Coordinator (or designated official) for good cause may deny assistance (Section 1.3 of these policies applies). False information provided by an applicant for assistance or other fraudulent actions taken for the purpose of receiving financial assistance from this program, will be grounds for denial of assistance and may be referred to the Clallam County Prosecuting Attorney s Office for possible legal action. Failure to meet program eligibility requirements, income over guideline amounts, inadequate required documentation, or no clearly definable and/or verifiable emergencies are other valid reasons for denial of service. The Veterans' Coordinator (or designated official) will make the determination for the basis of denial of assistance, based on 6 The only exception to this will be a warrant payable to the widow or widower, of a deceased veteran, who has already paid a funeral bill. Policy 950 Page 6

realistic and prudent reasoning and considering all facts and policies relevant to each request. 4.6.1. Divorce Remarried Spouse or Widow A divorced spouse of a living or deceased veteran, is ineligible for assistance. A widow(er) of a deceased veteran who has remarried is also ineligible for assistance. 4.6.2 Fraud and/or Abuse If the Veterans' Coordinator (or designated official) or other staff suspect fraud, criminal intent/activity or abuse of the system by an applicant, the matter may be referred to the Veterans Affairs Advisory Committee. The Committee may, at its discretion, refer the issue to the Prosecuting Attorney s office for investigation and possible legal action. If fraud or criminal activity is legally established, the applicant will be prohibited from receiving any future assistance from this fund..5 DENIAL OF SERVICE APPEAL PROCESS 5.1 Complaints or Appeals If a veteran feels s/he was treated improperly or denied assistance unfairly, s/he has the right of due process and may appeal the Veterans' Coordinator s (or designated official) decision to the Veterans Affairs Advisory Committee. All appeals will be heard and adjudicated by the Veterans Affairs Advisory Committee. 5.2 Non-Appealable Issues The following circumstances or facts are not appealable issues: Less than 12 months residency in this state No Wartime Service Not current resident of Clallam County Does not comply with required time interval since date of last assistance No legal veteran's status 5.3 Appeal Process Procedures The applicant must submit, in writing, a dated and signed statement on an appeal form, provided by the Veterans Coordinator (or designated official) describing in detail any alleged or perceived discrimination, improper treatment and/or reasons they feel they Policy 950 Page 7

were unjustly denied assistance by the Veterans Coordinator (or designated official). The appeal form may be submitted by mail or in person at the Commissioners Office. Upon receipt of said appeal, the Veterans Coordinator (or designated official) will contact the Chair of the Veterans Affairs Advisory Committee or any other two committee members, if the aforementioned is unavailable, to notify them of receipt of the appeal. The committee members will contact the appellant, in a reasonable and timely manner, to arrange an appeal hearing before the committee, with the Veterans Coordinator (or designated official) present, as soon as feasible. At the appeal hearing, the appellant may provide oral and/or written testimony in support of their appeal. After the appeal hearing, the committee will consider the written appeal, oral statements by the appellant and all documentation pertinent to said appeal. After taking evidence and considering all facts of the appeal, policies and applicable laws, the committee will contact the appellant with their decision of the appeal both by phone, if possible, and by U.S. Mail. The decision of the committee regarding the disposition of the appeal will be binding and final regarding Clallam County and the Program. 5.4 Further Appeal (Due Process) Section 5.3 above in no way limits an applicant s constitutional right of due process of law, as described in the Fifth Amendment thereof..6 AUTHORIZED USE OF FUNDS 6.1 Assistance Defined The intent of the original and subsequent legislation regarding the, precedent procedures and interpretations by other counties, actions by the Clallam County Board of Commissioners and a long-standing consensus of the veterans organizations in this County have defined the use of the Veterans Relief Fund as an Emergency Assistance Program. Accordingly, each application for assistance will be evaluated in the context of an emergency need. This program is not intended as a supplemental income source or an annual entitlement. 6.2 Eligible Items/Services for Assistance Food, shelter, limited emergency medical care, necessary utilities, limited transportation, burial assistance, in accordance with RCW 73.08.070, and other reasonable emergency needs that may arise are all legitimate expenditures of the Relief Fund. The Veterans Coordinator (or designated official) should use prudence and discretion in determining an Policy 950 Page 8

emergency need and voucher appropriate amounts provided for such relief. The Veterans Coordinator (or designated official) will not accept lost or stolen cash, as an emergency to qualify for voucher assistance. It is not the purpose of this fund to provide help as a result of carelessness. Individuals are responsible for the security of their personal funds, just as anyone else would be. 6.3 Primary Service Location All warrants are issued at the Clallam County Commissioners Office, located at 223 East 4 th Street, Port Angeles, WA 98362. 6.4 Schedule of Assistance A schedule of authorized assistance benefits and maximums for each is maintained as Appendix B to this policy. The Veterans Affairs Advisory Committee shall review the schedule at least biannually. Recommendations for modification will be made to the Clallam County Board of Commissioners who shall have final authority for approval of uses of the fund and maximum benefits..7 VETERANS COORDINATOR POSITION AND DUTIES 7.1 Defined The Veterans Coordinator (or designated official) shall be the primary program operations manager for the overall daily operation of the Veterans Relief Fund Program. The Veterans Coordinator (or designated official) will be an employee of Clallam County. Prior to appointment of any new Veterans Coordinator (or designated official), the Veterans' Affairs Advisory Committee will be notified and may comment on such proposed appointment. 7.2 Veterans' Coordinator s Decisions and Actions The Veterans Coordinator (or designated official), and other person(s) providing claims services as delegated pursuant to 950.4.1, shall interpret and apply when appropriate, these Policies and Procedures as liberally as possible when evaluating a veteran s request for assistance. The benefit of doubt may be applied in favor of the veteran, at the Veterans' Coordinator s (or designated official) discretion, when circumstances regarding emergent need and eligibility are borderline and/or questionable. It is the position of the County, that all veterans, who have served our country honorably, deserve nothing less than to be treated equally, with respect, dignity, compassion and fairness. Policy 950 Page 9

The Veterans' Coordinator (or designated official) will use sound judgment, reason, and prudence in making all decisions regarding applications for assistance from this program. 7.3 Relationship with Veterans' Organizations The Veterans' Coordinator (or designated official) will strive to maintain positive working relationships with the representatives of approved Veterans' Organizations Post/Chapter and with members of the Veterans' Affairs Advisory Committee. Members of veterans' organizations will cooperate and consistently follow these policies and procedures when processing claims for assistance. Policy 950 Page 10

APPENDIX A Service Officer s Checkoff List DD-214 (certified copy or original) Veterans' status (see form 03) State of residency (one year) Photo identification County of residency Authorization for release of information (see form 04) Income verification (if no income claimed, veteran must complete checklist; see form 02) Utility shut-off notice Landlord statement (eviction notice; see form 05) Documents supporting the emergency Copy of any document to establish or verify eligibility Death certificate, marriage certificate, birth certificate/or other document for dependent (circle document required) Advise applicant as to return/contact date Service Officers submit forms 1-6, as applicable for supporting documents Signature indicates veteran has been informed of return contact date: Name Date Post Officer Signature Date Initiating officer s comments: FORM 01 Policy 950 Page 11

ASSISTANCE APPLICATION Date Service/Post Officer s Name Veteran Information: Name Address (Please print; include street, number, city, state, zip code; must be a resident of Clallam County and Washington State for one year.) Date entered service Date of discharge Type of discharge Service number VA file number Income/Assets: Social Security Retirement/Pension Welfare Disability Unemployment Other Wages/self-employment TOTAL AMOUNT FROM ALL SOURCES TOTAL ESTIMATED ASSETS (auto, home, bank accounts, etc.) = = = = = = = = = Dependents: List all persons living with you and relationship (spouse, children, friend, age, etc.) Estimated cost of those living with you: $ Statement of need: I hereby declare under penalty of perjury under the laws of the State of Washington that I have read or have had read to me all questions and answers contained in this application and that my answers are true and accurate to the best of my knowledge. Signature of applicant Date Place of signing Witness Date Place of signing (post officer assisting application) FORM 02 Policy 950 Page 12

RELEASE OF INFORMATION By signing this form, you are giving your permission to have information shared with other departments, agencies, and organizations. You are also giving permission to use your social security number to locate your records. I agree that agencies can use the information I have given and my social security number to facilitate my application for s. Information can be shared by: United States Departments of Labor, Health & Human Services, Agriculture, Housing and Urban Development, Office of Community Services, Social Security Administration, Veteran s Administration, State of Washington Department Affairs, Department of Social & Health Services, Job Training Partnership Administration, Department of Revenue, Motor Vehicle Division, Department of Corrections, Department of Community College Services, Employment Security Department, Clallam-Jefferson Community Action, Salvation Army, Serenity House, Healthy Families of Clallam County, and Community Services Department. Also: Any other agency or person that I submit information/documentation to, or other state, community or private agencies that has or is able to provide assistance may have this information. I understand that information about my case is private. It cannot be given to others without my consent. I have read the blocked information above and signify my approval by signing this form. Name SSN: (please print) Signature Date: FORM 03 Policy 950 Page 13

LANDLORD STATEMENT Emergency financial assistance is available for veterans or their families. The veteran must meet eligibility requirements as set forth by RCW 72.08. The information requested below is CONFIDENTIAL. Process in accordance with RCW 40.145-070. Veteran s Name Phone No. Address (mailing address) (City) (State) (Zip Code) I,, authorize my landlord/managing agent to furnish information regarding rent, family size, and penalties because of late rent payments to the Veterans' Coordinator (or designated official). Applicant s signature Date: (When a conflict arises regarding who is the landlord and who is the property owner, contact the Assessor s Office to determine who is the landowner.) To Landlord/Property Manager The veteran named above has applied for assistance in paying his/her delinquent rent. The following information is requested: Landlord/Owner: Phone: Address (mailing address) (City) (State) (Zip Code) Veteran s Address: Monthly Rent: Amount Due: Date Due: List penalties: How long has veteran resided in your unit? How many people occupy unit? Who is rental agreement signer? Description of rented premises: I hereby declare, under penalty of perjury under the laws of the state of Washington that the above information is true to the best of my knowledge. Landlord/Property Manager s Signature Place of signing: Date: FORM 04 Policy 950 Page 14

ELIGIBILITY CHECKLIST Veteran s Name Are you receiving financial assistance? If so, how much do you receive? How long have you received this assistance? If you are unemployed, you must be registered with the Veteran s Section of Job Service. Bring proof of registration. To establish eligibility for financial assistance, please contact the following agencies: Department of Social & Health Services 138 West First Street Port Angeles, WA 98362 (DSHS grant, GAU, GAX, GAS, TANS, medical food stamps) Social Security Office 138 West First Street Port Angeles, WA 98362 (SSA, SSI, SSDI) Employment Security 1601 East Front Street Port Angeles, WA 98362 (Unemployment compensation) Washington State Job Service Registration 1601 East Front Street Port Angeles, WA 98362 (Veteran s section) If you are not receiving benefits from any of the above, you need a statement that no benefits are available to you at this time. FORM 05 Policy 950 Page 15

AUTHORIZATION FOR PAYMENT Veteran s Name SSN (please print) Address (mailing address, city, state, zip code) Veteran s Spouse (The veteran s spouse listed above has been found to be eligible under the provisions of RCW 41.04.005 for assistance as per RCW 73.083.010.) For payment of $ to be paid to: 1 (name of vendor or other agency) 2 (name of vendor or other agency) 3 (name of vendor or other agency) Utility account number This confirms recommendation for payment in the amount of $ (under RCW 41.01.005 and 73.083.010) Signature Date Commander Signature Date Adjutant, QM or Service Officer Signature Date Adjutant, QM or Service Officer FORM 06 Policy 950 Page 16

DENIAL FORM Veteran s Name SSN (please print) Date Reason(s) for denial: This confirms recommendation for denial by the Review Board Signature Date Commander Signature Date Adjutant, QM or Service Officer Signature Date Adjutant, QM or Service Officer FORM 07 Policy 950 Page 17

APPEAL FORM Date You have ten (10) working days from the date of mailing of the denial to present an appeal. Contact the officer that initiated your original claim. Basis of Appeal: Signature of appellant: Name Date (please print) Address (mailing address, city, state, zip code) SSN Phone FORM 08 Policy 950 Page 18

ANNUAL STATEMENT OF INTENT TO FURNISH RELIEF Name and Address of Veterans' Organization: Phone: Email: Officers: Commander: Address: Phone: Email: Adjutant: Address: Phone: Email: Quartermaster: Address: Phone: Email: Service Officer: Address: Phone: Email: To: Clallam County Auditor: Please consider this as our official, annual statement of intent to furnish relief through the Veterans Association as required by RCW 73.080.040. Commander s Signature: Date: FORM 09 Policy 950 Page 19

APPENDIX B Schedule of Assistance RELIEF CATEGORIES for applications are detailed below. All requests are classified into one of the following categories: food, rent, utilities, medical, burial, and miscellaneous. 1) FOOD a) There is no limit to the number of times an applicant can receive assistance. However, assistance is intended for emergency use. b) Assistance is to be used for necessities only. No alcohol or tobacco products may be purchased and the warrant will bear a stamp stating this. Sundries may be purchased but should be for necessary items like paper products and toiletries. Purchases of prohibited or questionable items will be documented in the veteran s record and will be considered grounds for termination of assistance. c) Proper identification must be presented to the vendor at the time of the purchase. No cash, coupon or credit of any type is to be given if food purchase is less than the amount of the warrant. d) Food vouchers shall be issued as follows: (1) Single veteran $150 (2) Spouse of deceased veteran $150 (3) Single veteran with children $150 + $100 for each nonemancipated, minor child (4) Married veteran $250 + $100 for each nonemancipated, minor child (5) Spouse of deceased veteran w/children $150 + $100 for each non-emancipated, minor child (6) Surviving children of deceased veteran $100 for each nonemancipated, minor child e) The County will maintain a list of grocery vendors who will accept warrants from the County. The veteran will be given a choice of any of the grocers on the list. f) Food vouchers may be issued to selected restaurants when a veteran is handicapped and/or a situation exists where it is not practical to issue a warrant for groceries. 2) RENT a) Rental payments are used to assist a veteran to remain in a domicile or to provide temporary shelter. Rent assistance is usually given only once a year but in an emergency situation, may be granted more than once. b) A rent applicant must provide proof of residency within the County. Acceptable documentation would be a rental agreement in the applicant s name or rent receipt. c) Rent is not paid to relatives of the applicant. d) Written notice from the landlord is required to verify that the tenant is behind in rent payments. Issue Date: May 21, 200 Policy 950 Page 20

e) Rent assistance depends upon the circumstances of the applicant and is determined in an interview conducted by the Veterans' Coordinator (or designated official) f) Use of assistance for rental deposits, such as first and last month and damage deposit, is allowed but must be refunded to the Relief Fund. This will be stated on the warrant. 3) UTILITIES a) Utility assistance is granted for electricity, water, and bottled gas such as propane, fuel oil and firewood. Assistance for electricity, water and bottled gas is only paid to avoid a shut-off and requires proof of a shut-off notice. It is the responsibility of the Veterans' Coordinator (or designated official) to contact the utility company and verify the amount of assistance required preventing a shut-off. b) Telephones are not considered a necessity and do not qualify except when a medical necessity exists, in which case, assistance with telephone costs can be considered. c) It is required that the last (3) consecutive monthly bills be submitted with the application. d) Use of assistance for utility deposits is allowed but must be refunded to the Relief Fund. This will be stated on the warrant. 4) MEDICAL ASSISTANCE a) Medical assistance may be granted to aid qualified applicants for the purchase of medical necessities. The Veterans' Coordinator (or designated officer) must consider these requests only on an emergency basis. b) Assistance may be provided for: 1) Prescriptions 2) Overdue medical/dental bills (billed within the last twelve months) 3) Eye glasses, denture repair, other medical appliances, as approved 5) BURIAL a) Up to $500 (but not less than $300 RCW 73.08.070) may be paid to the indigent spouse or dependent children upon the death of a veteran, his/her spouse, or child. This allowance is to assist with burial expenses and requires a copy of the death certificate. 6) MISCELLANEOUS a) Miscellaneous assistance includes travel and clothing under the following circumstances (1) Travel expenses are allowed for unusual medical purposes. Assistance is granted either by purchase of a ticket for public transportation or providing a voucher to purchase adequate amounts of fuel to perform travel. (2) Clothing is limited to required, specialized clothing for employment such as uniforms or work shoes. Issue Date: May 21, 200 Policy 950 Page 21