Each individual who is required to sign the Common Application Form (PA 600) must give the County Assistance Office (CAO) true and complete information on everything that may affect eligibility. An individual must accurately report changes described in Section 170.2. Changes must be reported by the tenth day of the month that follows the month of the change.
Example: On August 15, Mrs. Watkins is notified that she will receive unemployment compensation (UC). She must report this change by the tenth day of the month that follows the month she receives her first UC payment.
An individual who begins working must report employment by the tenth day of the month that follows the month of the start date.
Reminder: The CAO must scan or copy and save pay stubs and/or employer statements used to determine eligibility and grant amount. The CAO must follow this process at application, at renewal, at SAR review, and any time an individual reports new earned income. The CAO must verify actual hours worked to complete the federal TANF reports.
Example: Mr. Smith begins working August 5. He must report his new job by September 10. See Section 170.5.
An individual who is enrolled in SAR must also report changes on the SAR form. See Chapter 171, Semiannual Reporting.
The CAO will tell each individual, in terms that they can understand, about the requirement to report changes. Discuss responsibilities with each eligible individual and set up a plan for reporting.
At application and at renewal, the CAO will have the individual and other required persons sign the affidavit on the PA 600. The affidavit states:
“I understand that I can be penalized by fine, imprisonment or reduction of benefits for making false statements or not reporting changes in income or resources, household composition, address, or any other factor which may affect eligibility.”
If a check is issued, the statement below is printed on the back. The CAO will read the statement to each individual and explain that the individual is signing it every time they sign a check:
“By endorsing this check, I certify that I have notified my county board of assistance of all changes in the facts as stated in my application for assistance and that neither I nor any member of my family has any earnings from employment or other resources which would affect the eligibility of myself or my family which I have not reported to said board. I know that I can be penalized by fine or imprisonment, or both, for any false statements.”
Revised July 30, 2024, replacing September 19, 2012