Form 140 MT 19

							APPENDIX F                                                     FORMS INSTRUCTIONS


              Form 140- TANF Mandatory Forms Checklist-Reviews

Purpose              Form 140 is a checklist that is used with all reviews to assist the case
                     manager in validating that the appropriate Mandatory Forms were
                     completed with the client. The intent is to reduce/eliminate
                     deficiencies and improve accuracy.

Program              TANF

Source               Form 140 is available only online in Word format at
                     http://www.odis.dhr.state.ga.us/3000_fam/3390_tanf/MAN3390.doc,
                     and may be printed locally.

Form Completion      This Form has six sections.
                     Section 1 is used to document the client specific information.
                     Section 2 is used to document the case specific information.
                     Section 3 is used to document the mandatory forms to be completed
                     are provided at all TANF reviews. Both the case manager and the
                     reviewer initial or check this section of the form.
                     Section 4 is used to document the forms that are conditional to the
                     AU’s situation. Both the case manager and the reviewer initial or
                     check this section of the form.
                     Section 5 is used to document the forms that are used for GRG
                     MSP/CRISP reviews.
                     Section 6 is for the case manager and the reviewer to document any
                     other additional comments.
                     The client’s signature is not required. However, the case manager
                     and the supervisor or the rewire must sign and date the Form.

Routing              The original Form 140 must be filed in the case record.




VOLUME I – TANF MT19– 10/08                                                     Form 140