Form 249LS � TANF Lump Sum Ineligibility by VEZfoS


									APPENDIX F                                                     FORMS INSTRUCTIONS

                  Form 249LS – TANF Lump Sum Ineligibility

Purpose              Form 249LS is used to notify an assistance unit (AU) of the initial
                     action taken as a result of the receipt of lump sum income by an AU
                     member or by an individual whose lump sum income is considered in
                     determining the AU’s eligibility or benefit amount.
                     Form 249LS also notifies the AU when the period of ineligibility
                     changes for one of the following reasons:
                            The verified information is different than the information
                             originally provided.
                            The period of ineligibility is shortened because of a change in
                             the family’s circumstances.
                     Form 249LS also includes information on the AU’s hearing rights
                     and the AU’s right to request a continuation of its benefits.

Program              TANF.

Source               Form 249LS is available only online in WORD format at
                     and may be printed locally.

Form Completion      Complete Form 249LS within two working days of the date that
                     receipt of the lump sum is reported, the date verification is received,
                     or the date it is established that the period of ineligibility must be
                     Address the notice to the grantee relative.
                     Indicate the action taken by checking the appropriate box.
                     Complete the rest of the form in full as indicated.

Routing              Complete Form 249LS in duplicate.
                     Mail or give the original to the AU. File the copy in the case record.

VOLUME I – TANF MT 23–01/11                                                  Form 249-LS

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