Hardship Extension Statement Of Understanding

• I have been told that if I request an extension of my months of cash assistance, my request will be reviewed and I will be advised by the RWB of the outcome of the decision about my request. To receive an additional extension, I must request the extension from my Public Assistance Specialist and/or the Regional Workforce Board.
• If I do not request an extension at this time, I reserve the right to request on at a later date.
• I have been told that any extension of months of cash assistance is counted as part of my lifetime limit of 48 months.
• I have been told that if I fail to meet any program requirement, not just work requirements, I may be sanctioned and
  my cash assistance and/or food stamp benefits may end.
• I have been told that if I am denied an extension of cash assistance, I have the right to request a fair hearing and my
  request for a Hardship Extension may be reviewed by the office of Family Safety since my cash assistance is ending.
• I understand that I always have the choice not to receive cash assistance and that it is my responsibility to inform my
  Public Assistance Specialist if I choose not to receive cash assistance.

Privacy Statement

I understand that I am required by law to provide my social security number(s) or proof that I have applied for a social security number if I do not currently have one to receive TANF funded benefits/services. This is mandatory under the Social Security Act (42 U.S.C. 1137). If I do not have a social security number and have not applied for a social security number, I can request help with filing an application. The social security number is used to administer the program, including determining eligibility, attributing the receipt of services, correspondence and participation to my case, as well as for reporting purposes.