The caseworker must explain:
Responsibilities both for the person and for the CAO assisting the person.
Right to appeal and have a fair hearing.
Good cause including good cause for domestic violence (DV).
Penalties for noncompliance with eligibility requirements.
NOTE: For domestic violence AMR’s please see CAH 108.11 Completing the Domestic Violence Agreement of Mutual Responsibility.
Both the person and caseworker must initial and date the bottom of each page to acknowledge that all information on each page was discussed and reviewed thoroughly with the individual.
The caseworker must follow these guidelines when completing the AMR's “Plan for Supporting Myself and My Family:”
Make sure the AMR is readable. Printing is easier to read. Use a pen, not a pencil, or complete the form on DocuShare.
Make sure the AMR is in a language the person can understand. This may require the use of an LEP (Limited English Proficiency) translator so the person can read the AMR. See LEP Resources, LEP.
Follow the language and questions in each section to assist in engaging a conversation with the person when discussing goals and responsibilities.
The caseworker must enter the following information on the AMR:
The person's line number in the case records.
The person’s full name.
The case record number and county code.
The phone number where the person can be reached.
The date the AMR is completed.
The following information should be completed by the caseworker and reviewed with the person signing the AMR:
Number of Cash days:_____
Highest level of education completed:_____
Birthdate of youngest child:_____
Paid Work Experience weeks completed:_____
Allowable Community Service hours per week:_____
The person must list a long-term goal and the first steps in obtaining their goal. Persons with education or training goals will usually have an education goal plus a long-term job-related goal.
Examples:
Long term goal: "To get my registered nurse (RN) license".
First steps: "To successfully completed the fall semester at Harrisburg Area Community College (HACC)".
Explain to the person that the long-term goal is for the person or family to become financially self-sufficient without depending on Cash Assistance. The best way to do that is through a job or continued education. Discuss with the person their plan for achieving this goal.
There may be more than one goal.
A goal may relate to employment or other activities to progress toward self-sufficiency.
Goals are not the same for everyone. They are based on the person’s situation and possible barriers that may need addressed.
Goals are jointly agreed on by the caseworker and the person.
Goals are the person’s, not the caseworker's.
Goals should be reasonable and attainable.
Earn a bachelor’s degree in social work and become a social worker.
Get a job as a nurse’s aide.
Continue to attend school, making satisfactory progress as defined by the college.
Finish my GED.
In the “Barriers to Goal Achievement ” the caseworker must complete the Job Readiness Assessment checklist (see CAH 135.11, RESET Enrollment Status) to identify barriers and criteria to determine the appropriate RESET participation project referral. The participation requirement will be based on how the client answers the Job Readiness Assessment questions. See Job Readiness Assessment Guide.
The CAO should include any barriers that may prevent an individual's ability to participate in an activity or that the person chooses to disclose.
Examples:
Full or partial mental or physical disabilities.
Domestic violence (See CAH 108.11, Completing the Domestic Violence Agreement of Mutual Responsibility).
Substance abuse.
Children with disabilities or serious health problems.
Homelessness.
Criminal history.
Limited English proficiency.
NOTE: When domestic violence is a barrier, to ensure confidentiality, the caseworker must never document it on the AMR, but instead refer to domestic violence as "supportive services". The caseworker must document the circumstances and information about domestic violence in the case record narrative.
If a TANF program requirement has been waived because the person cannot safely apply for support or participate in work activities due to DV, the AMR must document that a waiver of that requirement has been granted. Again, no reference to “domestic violence” should be made on the AMR, even if it was the reason for the waiver, however, document the waiver due to supportive services, and for how long the waiver is in effect including dates. Although recipients may self-attest on the PA 1747, a referral to DV services must be made each time the AMR is created or updated. The caseworker must note the reason for the waiver in the case narrative. See 108.11 Completing the Domestic Violence Agreement of Mutual Responsibility.
The AMR serves as the federal service plan for domestic violence waivers.
Serious health problems, such as HIV/AIDS, drug or alcohol addiction, and mental health issues, may be barriers to employment. The caseworker must not note the specific condition on the AMR. Instead, the caseworker must note that there is a serious, chronic, or acute medical condition and record specific information about the medical condition in the case narrative.
The caseworker must do the following:
Consider barriers that the person must overcome, and use the person’s strengths to decide on the most appropriate activities.
Always address barriers to goal achievement, such as language, education, transportation, or child care with the person.
Develop a plan, such as “Take ESL classes,” to help the person reduce the barrier’s effect on the goal of becoming self-sufficient. Any steps the person takes to improve their situation are steps in the right direction. The person’s participation is critical.
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07.64 AMR Section: “Employment & Training Status”
In the "Employment & Training Status" section, the caseworker must indicate the person's employment and training status by checking the appropriate box:
The “Participation Status” section must show that the CAO reviewed the good cause and exemptions status of each mandatory person. The caseworker must check the appropriate box provided whether good cause or an exemption is approved, denied, or not applicable.
Caseworkers should provide the reason for the good cause or exemption determination and any barriers having an impact on the person's ability to work or participate in an activity.
107.651 Good Cause for Participation
When reviewing a mandatory individual’s situation to decide if there is good cause for reducing RESET participation requirements the CAO will:
The “Agency Assistance and Referrals” section must include a list of all supportive services that are provided to the person plus any referrals made to other appropriate community agencies or organizations to address the barriers listed in AMR Section "Barriers to Goal Achievement".
Examples of supportive services:
Childcare; list the address and phone number of the local area Early Learning Resource Center (ELRC).
Transportation
Clothing
Book allowances
For domestic violence, offer local county supportive services and provide referrals and contact information.
NOTE: The AMR must include a statement that the person is required to provide a receipt within 14 days of receiving Special Allowance (SPAL) money for supportive services.
Examples of community agencies:
Counseling programs
Housing assistance
Children’s services
The caseworker must include actions to be taken by the person to address or eliminate each barrier identified on the AMR.
The plan to address barriers should be in clear, meaningful steps and very specific. If something is not agreed to on the AMR, the individual cannot be cited or sanctioned for not doing it.
Example: If a person is on probation or parole or is subject to payment of fines and costs, this section should state that the person must comply with probation or parole terms or with an approved payment plan for fines and costs.
Appropriate AMR text: "Continue making payments to the court for outstanding fines and costs until the amount is paid in full".
For domestic violence, appropriate text would be: "Referred to supportive services".
When a serious health problem exists, and the person is receiving treatment for it, an appropriate AMR statement would be: "Continue to follow treatment plan prescribed by your doctor".
If the person is a candidate for SSI or SSDI benefits and referred to the Disability Advocacy Program (DAP), the caseworker must include that information in this section and write that the person must apply with Social Security, keep all appointments and agree to appeal the decision if the SSI or SSDI application is denied for medical reasons. The caseworker must explain to the person that the DAP advocate will help with the appeal process.
See Supplemental Handbook, Chapter 820, Section 820.6.
If good cause for partial participation is granted in the AMR section “Participation Status”, the “Participation Activities” section must be completed with the specific activities or employment the person agrees to and the number of hours per week the person is required to participate in a program or activity.
If good cause or an exemption is denied or not applicable in the AMR Section "Participation Status", the "Participation Activities" section must be completed with the specific activities or employment the person agrees to and the number of hours per week the person is required to participate in a program or activity.
These activities are required for all individuals who are mandatory to participate in RESET.
Supplementary activities are available if additional hours are needed to meet the minimum work requirement after the required activity hours are met or when all opportunities to participate in a countable activity have been exhausted or are not available.
See Cash Handbook Chapter 135.2 Employment and Training Activities.
The activities or employment should relate to the person's long-term goal and first steps that are written in the AMR Section "Goals".
The AMR must include name, address, and phone number of the program or activity. In addition, list the specific date and time the person should report to the program or activity.
Example: if the long term goal and first steps is to become an RN, the participation requirements should read
What: KEYS- Attend college classes for RN degree.
Where: HACC, 1 HACC Drive, Harrisburg, Pa 17110 (717) 780-2400
When: Report to classes beginning Monday, September 1, 2023
Hours: M,W,F 8-12 and T,Th 1-5
You must participate in 20 hours per week.
This section is divided into two sections, for situations where the person is participating in two activities.
NOTE: The caseworker must write the number of hours the person is required to participate in each program or activity.
If the person chooses employment, the caseworker must enter work-related activities in the first section. Entries in this section should focus on job search activities. If appropriate, the caseworker must enter the number of hours the person is working.
Activities may include those related to education and training.
After completing this section, the caseworker must review the "Your Rights" and "Good Cause" statement with the person.
After AMR Section: "Participation Activities" and "Your Rights" and "Good Cause" statements, the caseworker must enter the following:
Their name and phone number (or the appropriate caseworker's name and phone number).
A date the person is expected to report to the CAO on the status of the plan.
The date should be no later than the next renewal. The caseworker must let the person know that this progress report is very important.
Both the person and the caseworker must sign, date and initial page 3, the agreement statement of the AMR in the spaces provided below AMR Section: "Participation Activities" and must initial and date pages 1, 2, and 4 to verify that they have discussed and agreed on the AMR plan.
NOTE: The AMR is not a valid agreement without the appropriate signatures.
The caseworker must make sure the person reads and understands the agreement statement to the left of the signature lines at the bottom of page 3.
The AMR is a mutual agreement and should reflect what is agreeable to both the person and the caseworker. Advise the person that the AMR may be revised and updated as necessary to reflect any changes in circumstances. The person may ask that the AMR be revised and updated a necessary.
When completing an AMR for child-only cases, including kinship caregivers, the caseworker must remember that an adult caretaker who is not receiving Cash Assistance is not subject to RESET requirements. The AMR is completed for the benefit of the child rather than the adult. Below are guidelines for how to complete an AMR for a child-only case:
AMR Section, “Goals,” must show goals that benefit the child. For example, a long-term goal might be “To make sure the child completes their education.” First steps might be “To attend teachers’ conferences and school activities as needed.”
AMR Section, "Barriers to Goal Achievement", must be completed if the child is mandatory and subject to the RESET requirements. The caseworker should use the Job Readiness Assessment checklist (See CAH 135.11 RESET Enrollment Status) to identify barriers and criteria to determine the RESET program participation requirement and project referral
AMR Section “Employment and Training Status,” must reflect the employment and training status of the child, not of the adult caregiver. The child is exempt if under age 18 and working toward a high school diploma or GED. If the school-age child is not in school working toward a high school diploma or GED, the caseworker must review the employment and training status to determine whether the child is mandatory or exempt. The adult is not considered in the employment and training status review, because they are not subject to the RESET requirements. An exception is a currently sanctioned adult.
AMR Section, “Participation Status,” must show that the CAO reviewed the good cause status and exemption of a mandatory budget group member that is subject to the RESET requirements. The caseworker must check the appropriate box provided whether good cause or an exemption is approved denied, or not applicable and the reason for the good cause or exemption.
AMR Section, “Agency Assistance and Referrals,” must include a list of all supportive services that are provided to a mandatory child plus any referrals made to other appropriate community agencies or organizations to address the barriers listed in AMR Section: "Barriers to Goal Achievement" in order to meet the RESET requirements.
AMR Section, "Participation Activities", is not applicable in a child-only/kinship caregiver case. The caseworker must write "Child-only case, not applicable" in this section. The exceptions to this are a child who is not RESET exempt or an adult who is currently sanctioned. The caseworker must review RESET requirements.
This section must reflect actions to be taken for the benefit and well-being of the child. The adult has responsibilities to the child, such as making sure the child attends school every day and keeping all doctor appointments and immunizations current. These responsibilities are considered "family responsibilities" and should be listed in this section.
Determining eligibility for Extended TANF (ETANF) requires a partial renewal, including a new AMR or an update to an existing AMR.
The AMR must specify an Extended TANF hardship criteria and the reason the adult(s) who have over 1830 TANF days qualify for that ETANF hardship criteria. The AMR must be detailed and specific to the adult’s circumstances. For determining eligibility for Extended TANF, see Cash Assistance Handbook Chapter 176, Section 176.32.
NOTE: It is not necessary to keep track of day counts on an AMR for Extended TANF adults. Extended TANF does not have a time limit.
In the “Barriers to Goal Achievement” enter one of the four ETANF Hardships as follows:
ETANF Hardship Criteria – Supportive Services
ETANF Hardship Criteria – MPP
ETANF Hardship Criteria – Mandatory RESET
ETANF Hardship Criteria – Deferred Referral
(See CAH 105.261)
A new or updated AMR may be completed by telephone interview for the partial renewal. In a telephone interview, the caseworker must:
Explain to the individual the reason a new or updated AMR is necessary.
Narrate the reason in the case record narrative.
Explain to the individual that they may verbally sign the AMR or request the updated or new AMR be mailed, faxed or emailed for signature. (See Section 107)
The individual must initial and sign the AMR and return it to the CAO within 30 days of the date of the CAO signature.
As circumstances change, an individual may qualify for Extended TANF under another ETANF hardship criteria. Any changes between hardship criteria requires a partial renewal, including a new or updated AMR.
The CAO must distribute the AMR as follows:
Original copy of the AMR is given to the individual.
One complete copy with signatures should be scanned and imaged to the case record.
NOTE: This includes any AMR updated and sent to the individual for signature and return. An AMR mailed to the individual must be completed, signed and dated and returned within 30 days from the date of the CAO signature on the AMR. A signature is required to verify that the individual is complying with all AMR activities.
One copy for the Service Delivery Area (SDA) for persons who are participating in a contracted program.
One copy for the Employment and Training Unit (optional).
When the AMR is completed by phone, sent for signature and then returned to the CAO, by mail, fax, or electronically, with the person’s signature and initials in the appropriate sections:
When the AMR is completed by phone with Telephonic Signature
The CAO can receive an individual’s oral attestation of the AMR information, including the individual’s signature, over the phone. The CAO will narrate that the individual’s identity was verified using the last four digits of the Social Security Number, Date of Birth, Address, and phone number. The CAO will document the oral attestation on the AMR and in the case narrative to show that the individual has orally signed and initialed the appropriate sections of the AMR.
The narrative must state the following:
Completing an AMR through DocuShare and mailing locally, the CAO will:
Completing an AMR through the Electronic Client Information System and mailing centrally, the CAO will:
If the individual or other household members opt out and choose to complete the AMR by mail, it must be returned within 30 days from the date of the CAO signature on the AMR. Their decision to complete the AMR by mail must be narrated. If not returned within 30 days, the applicant/recipient who failed to complete the AMR is ineligible for TANF. In ETANF cases, the entire household is ineligible if the applicant/recipient fails to complete the AMR.
It is important that the CAO follow this procedure in detail. If there is an unsigned AMR in Imaging that is not annotated as orally signed and/or the narrative is missing, this will result in a quality control error and a possible overpayment for the household.
An individual with Limited English Proficiency (LEP) should be provided two copies of the AMR, one in English and one in the preferred language of the person. The English copy may be needed for E&T contractors or others who assist the person, as well as for the CAO. Both AMRs should be scanned and imaged to the case record. Please note that currently there are translations of the AMR template in Spanish, Russian, Vietnamese, Chinese, Nepali, Swahili, Arabic, French, Ukrainian, Haitian-Creole, Dari, Pashto, Turkish, Farsi, Burmese, Albanian, and Cambodian in DocuShare.
OPS210201 Limited English Proficiency (LEP) Resources and Procedures
If an existing AMR is updated, the CAO must give the individual a copy of the updated AMR.
The case record narrative should state that the AMR was completed, explain the plan for the person to report changes, meet goals, and include any other information to help with follow-up activities. It is not necessary to repeat the activities and tasks listed on the AMR.
After the AMR is completed, the CAO caseworker must make sure that future case record narratives include the following:
Track the progress of the person.
Note when follow-up contacts occur.
Note that supportive services or a good cause waiver for domestic violence are included on the AMR.
Note that changes or additions to the plan were made; and
Clearly establish any basis for adverse action if the person fails to participate in the activities listed on the AMR.
Updated April 29, 2025; Replacing October 3, 2023