The Application Process For TANF, Food Stamps, Medicaid, and SCHIP:

Chapter 4.
Application Forms

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Endnotes

All benefitprograms require applicants to complete a written application. This chapter compares the application forms used in the study sites for the four benefit programs.(1) Special attention is paid to features that can make completing application forms particularly difficult or confusing for immigrants and limited English speakers. The general accessibility of application forms in terms of where and how they can be obtained is considered first. This is followed by a description of the integrated application forms used in the study sites for TANF/FSP/Medicaid (and sometimes SCHIP as well), highlighting differences in length and areas of particular relevance for immigrants and limited English speakers. Applications for only Medicaid and/or SCHIP benefits are then described, focusing on the ways in which these program applications differ from integrated applications.

Application Availability

Making application forms available through a variety of sources increases accessibility because they are easier to obtain, provide individuals the ability to see in advance what types of information are required, and facilitate efforts to provide screening and application assistance. Welfare offices always have application forms available for in-person pick-up, but they are also available by mail in most sites and even over the Internet in some sites (see Exhibit 4-1). Application forms may also be made available in non-welfare office settings, such as public health clinics, food pantries, and Voluntary Resettlement Agencies (VOLAGs).

Exhibit 4-1:
Availability of Applications
Study Sites, 2001)
Site TANF Food Stamps Medicaid SCHIP
Arlington* Mail
Office
Mail
Office
Mail
Internet*
Office
Mail
Internet*
Office
Dallas Mail
Internet
Office
Mail
Internet
Office
Mail
Internet
Office
Mail
Internet
Office
New York Office Only Mail
Office
Mail
Office
Mail
Internet
Office
Raleigh Office Only Office Only Mail
Office Only
Mail
Internet
Office
Seattle Mail
Internet
Office
Mail
Internet
Office
Mail
Internet
Office
Mail
Internet
Office
Sedalia Mail
Office
Mail
Office
Mail
Office

Mail
Internet
Office

* Applicants can initiate the TANF and food stamps application process by downloading an online Request for Assistance form which can be filled out and mailed in but this action does not eliminate the need to fill out the full application and attend an eligibility interview.

In Dallas, Seattle, and Arlington, applications for all four types of benefits are readily available in the welfare office reception area and can also be mailed upon request to applicants or downloaded from the Internet. Both Texas and Washington also offer potential applicants a statewide on-line program that enables individuals to complete a self-screening to find out if they potentially qualify for different types of benefits. To apply for Medicaid/SCHIP in Dallas, for example, applicants can use an interactive on-line program that fills out the form for the applicant by asking a series of questions. When finished, the applicant can print and mail in the application. Washington has advanced online applications even further and provides individuals the opportunity to actually fill out and submit an application for TANF, FSP, Medicaid, or SCHIP using an interactive on-line program.(2)

In contrast, the only way that families in Raleigh can obtain an application for TANF and FSP is to physically go to the welfare office and request an application from the receptionist. Medicaid and SCHIP applications can be obtained by mail or at the welfare office.(3) In New York City, applications for cash assistance can only be obtained by visiting the welfare office, while applicants for food stamps-only and Medicaid-only can also obtain applications through the mail. In both Raleigh and New York City, SCHIP applications are also available through the Internet.

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Integrated Application Forms

The integrated application form is the product of earlier efforts to develop integrated eligibility systems that tied TANF, FSP, and Medicaid into a single eligibility package. Each study site has an integrated application that allows a person to apply for multiple programs at the same time (see Exhibit 4-2). With the exception of Raleigh, these applications can be used to simultaneously apply for TANF, food stamps and Medicaid. Raleigh has a joint application for TANF and Medicaid, and a separate application for food stamps. If the TANF/Medicaid applicant is also interested in receiving food stamps, they can indicate this on a checkbox and avoid having to fill out the separate food stamp application.

Application Length

Application length has been cited as a deterrent to completing applications in previous studies (O'Brien et. al. 2001). The length of integrated applications varies significantly by site. Including all instructions and other written information, the average length of integrated applications across the sites is just over 13 pages, ranging from a low of 6 pages in Seattle up to 18 pages in both Arlington and New York.(4) The length of an application is also affected by stylistic choices regarding font sizes and line spacing as well as the length and placement of instructions. Excluding pages that list only instructions, the applications average about 10 ½ pages and range from 5 pages in Seattle to 15 pages in Arlington. When describing the integrated application in Arlington, a worker remarked, "It's a book!" and noted that many applicants — regardless of English proficiency — feel overwhelmedby the sheer length of the application. Even in Seattle, where the integrated application is the shortest among our sites, some staff noted that the length and complexity of the application is difficult for some applicants.

U.S. Citizenship/Immigration Status

The integrated application typicallycovers U.S. citizenship in the first section of the application. The way in which an application solicits citizenship and immigration status of individuals in the household can allay or exacerbate any confusion, misgivings or fears that immigrants may have about applying for benefits.

Applications in the study sites request citizenship and/or immigration status in different ways. The Texas integrated application does not request immigration status information of all household members and is the only integrated application form that makes several efforts to clarify that applicants need only fill in citizenship and/or immigration status information about those in their family or household who are seeking assistance. In the first part of the application, there is a section called "Important Information for Immigrants." Within this section, there is a paragraph explicitly responding to concerns of households in which citizenship and/or immigration status is mixed. The paragraph states:

You can apply for and get benefits for eligible family members, even if your family includes other members who are not eligible because of immigration status. For example, immigrant parents may apply for benefits for their U.S. citizen or qualified legal immigrant children, even though parents may not qualify for benefits.

Under the section on "Citizenship and Immigration Status," there is a specific clause describing who must report the information requested in this section that states:

You will be asked to provide information about the citizenship or immigration status for all persons (including yourself) for whom you want assistance. If any of these persons do not want to give us information about his or her citizenship or immigration status, he or she will not be eligible for benefits. Other family or household members may still get benefits if they are otherwise eligible.

Exhibit 4-2:
Key Characteristics of Integrated Applications
Study Sites, 2001)
Sites Programs Covered Length Without Instructions* SSN Citizenship/Immigration Status Language Access Will Not Share Information about Non-applicants with the INS
All in HH Statement on Non-applicants All in HH Statement on Non-applicants Box Translated
Arlington, VA TANF, FSP, Medicaid 15pgs No Yes No Yes No No No
Dallas, TX TANF, FSP, Medicaid 8pgs No Yes No Yes Yes Spanish Yes
New York, NY TANF, FSP, Medicaid 10pgs No Yes No No Yes Spanish, Russian, Arabic, Chinese, Vietnamese, Haitian-Creole, French Korean, Yiddish No
Raleigh, NC (5) TANF, Medicaid ** No No No No No No No
Seattle, WA TANF, FSP, Medicaid 5pgs No No Yes No Yes Spanish, Vietnamese, Laotian, Chinese, Cambodian, Russian, Korean*** No
Sedalia, MO TANF, FSP, Medicaid 9pgs No No Yes No No No No
**  The joint application in Raleigh has two parts — Work First Assessment and application for Work First — neither of which is filled out in advance by the applicant. The assessment is 14 pages long and completed during a one-on-one screening session. Applicants provide the eligibility worker the information needed to complete the Work First application during the eligibility interview and the worker enters it directly into the computer.
***  The integrated application in Seattle can also be obtained in any other language, but it is not pre-printed.

The distinction between requiring information on the applicant but not others living in the household who are not otherwise eligible is further reinforced under the "Household Information" section of the application, which features two separate tables — one for applicants and one for non-applicants in the household. The second table only asks for the name and relationship of that (non-applicant) person to the applicant, and does not ask about citizenship or immigration status.

Two sites (Seattle and Sedalia) use integrated applications that request citizenship information and/or immigration status on all individuals in the household, regardless of whether they are applicants or non-applicants. For example, in the section of the Missouri integrated application where applicants must list all persons who live in the household, the applicant is asked to write-in whether or not each member of the household is a U.S. citizen (Yes/No), and, if they are not a U.S. citizen, to provide that person's alien number.

Social Security Numbers

A Social Security Number (SSN) is required of all persons who apply for benefits but is not necessary for non-applicant members of a household.(6) Integrated applications typically provide non-applicants the opportunity to write in SSNs along with those of the applicant(s). While having SSNs for non-applicants may make it easier to verify certain types of information for eligibility determination purposes, applications are supposed to clarify that disclosure of these SSNs is completely voluntary and that failure to provide an SSN will not adversely affect eligibility.(7) This is relevant for immigrant families with some members who are not eligible for assistance and do not have SSNs.

All integrated applications used by the study sites indicate that SSNs are not required of all members of the household. Some applications explicitly state that only applicants should submit SSNs, while others may request SSNs for non-applicants but also state it is not necessary to provide this information (see Exhibit 4-2). For example, the Arlington integrated application requests, but clearly does not require, the SSNs for all members of the household. The general instructions for filling out that section of the application instructs applicants to provide the requested information "…for everyone who lives in your home, even if you are not applying for that person. You may leave questions about citizenship, immigration and Social Security Number blank for anyone for whom you are NOT requesting assistance." This point is emphasized further in the specific column heading designated for SSNs, where the instructions reiterate that the applicant may leave the space blank for anyone not in the assistance request.

In New York, a clarifying statement about when SSNs are required appears in a separate instruction booklet that accompanies the integrated application. However, this information might be overlooked if the applicant does not carefully crosswalk the instructions with the application form, particularly since SSNs are requested on the actual application under the heading, "Social Security Numbers of Applying Household Members."(8) Advocates in New York City stated a preference to have the spaces blacked out where SSNs are collected from non-applicants and include no SSN-related questions for non-applicants — an approach found in the Texas integrated application.

The Texas integrated application does not have a space on the application to write down the SSNs of non-applicant members in the household. The application contains two tables that collect information about household members — one for applicants and one for non-applicants. SSNs are requested only in the table designated for applicants. In addition, different parts of the application used in Dallas include the following statements:

You will not have to provide Social Security numbers or immigration status information or documents for any family members who are not eligible because of immigration status and who are not asking for benefits.

You will be asked to provide Social Security Numbers (SSNs) for all persons (including yourself) for whom you want assistance. If any of these persons do not have an SSN, we can help you apply for one. Providing or applying for an SSN is voluntary; however, any person who wants assistance but who doesn't want to give information about his or her SSN will not be eligible for benefits. Other family or household members may still get benefits if they are otherwise eligible. If you are applying only for emergency Medicaid because of your immigration status, you do not need to give us information about your SSN.

Availability of Translated Applications

In an effort to make applications more accessible to immigrants and limited English proficient persons (LEPs), some sites make integrated applications available in languages other than English. Dallas, New York City and Seattle have integrated applications translated into one or more languages whereas Arlington, Raleigh, and Sedalia provideapplications in English only. Of the sites that have translated integrated applications, the number of non-English languages available ranges from one language (Spanish) in Dallas, to seven in Seattle, and nine in New York City (see Exhibit 4-2).

In Dallas, both English and Spanish versions are included in a single application form while translated applications in New York City and Seattle contain only one language per form. The integrated application in New York City is available in Spanish, Russian, Arabic, Chinese, Vietnamese, French, Korean, Yiddish, and Haitian-Creole. In Seattle, the state provides preprinted integrated applications translated into Spanish, Vietnamese, Laotian, Chinese, Cambodian, Russian, and Korean, and forms translated into any other language are available upon the request of local welfare offices (see Chapter 6 for more detail).

In addition to having translated applications, the application forms in Dallas, New York City, and Seattle contain a box which applicants can check if they want to have an interpreter at the eligibility interview, and if so, what language is needed. This "language box" is usually located near the beginning of the application, either on the first or second page. On the integrated application from New York City, there is also a question that asks if applicants prefer to receive notices in Spanish and English, or English only. In Seattle, caseworkers use the information from the language box on the application to note the clients' language preference in the computer system. If the caseworker marks that the applicant needs an interpreter, then all notices will be sent in the specified language unless the applicant states an alternative preference. Several staff in different sites noted that some LEPs may still prefer application forms and other written materialsin English because they are not literate in their first language and can find someone to help them interpret the English form.

Sharing Information with the INS (Public Charge Concerns)

Immigrants may be deterred from applying for benefits even when they or other family members are eligible for benefits because: (1) they do not understand or are confused by the complicated eligibility rules; (2) they are worried that information they submit to welfare agencies may be reported to the INS; and/or (3) they are afraid that benefit receipt will have a negative impact on legalization, naturalization, and their petitions for relatives to immigrate. The last two factors are known as "public charge" concerns, and are related to immigration law and regulations. We reviewed the integrated application to determine if they addressed such concerns; for example, stating that SSNs and U.S. citizenship/immigrant status information submitted on the application would not be shared with the INS. Including such a statement may be especially helpful in places where applications requestinformation on non-applicant members of the household (e.g., Seattle and Sedalia), since this information is not necessary in determining eligibility.

Only the integrated application used in Dallas explicitly addresses these public charge concerns (see Exhibit 4-2). In a section entitled, "Important Information for Immigrants," the Texas application contains the following statements:

If you or members of your family use Medicaid, the Children's Health Insurance Program (SCHIP), or Food Stamps, it will not affect your or your family members' ability to get a green card. The exception is if you use long-term institutional care, such as a nursing home.

SSNs are used to verify your family's income and to conduct computer matching with other agencies. We will not share your SSN with the Immigration and Naturalization Service (INS).

In contrast, two sites in the study — Sedalia and Arlington — use integrated applications that state the information on the application will be shared with the INS. The Missouri application specifically states:(9)

Any alien members of your household have to provide valid documentation of his alien status to the county office. The documentation may be verified with INS with certain identifying information. The response of INS may affect your eligibility and benefits level.

Similarly, the integrated application used in Arlington has a statement regarding SSNs under the section describing Verification and Use of Information. In reference to SSNs, this section states:

In addition, the Immigration and Naturalization Service (INS) will be used to verify the status of aliens. Any difference between the information you give and these records will be investigated.

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Medicaid/SCHIP Program Applications: Streamlined and Simplified

In addition to integrated applications, all sites in this study provide applications that may be used to apply for Medicaid and/or the SCHIP program (see Exhibit 4-3).(10) With the de-linking of Medicaid eligibility from cash assistance eligibility and the enactment of SCHIP, states have made concerted efforts to simplify Medicaid/SCHIP application forms. States have shortened the lengths of these application forms and designed simpler forms that are more comprehensible to lay readers with lower literacy levels.

States can choose to create separate or combined application forms for SCHIP and Medicaid for children, although states choosing a separate form for a non-Medicaid SCHIP program must still screen for Medicaid eligibility. Some states have created joint forms to screen children for both Medicaid and SCHIP (and sometimes food stamps). All of the sites in this study, with the exception of Arlington, have a single application to apply for both programs.

There are marked differences between integrated application forms and Medicaid/SCHIP application forms. Forms for these programs tend to be simplified and more user-friendly for immigrants and applicants in general. As described below, they are typically: shorter in length and easier to complete; request less information about non-applicants in the household; are more likely to be translated into Spanish; and provide statements that addresspublic charge concerns.

Shorter Application Length

Medicaid/SCHIP applications in the study sites are considerably shorter than the integrated applications. The average length of Medicaid/SCHIP applications (including instructions) across all sites is eight-and-a-half pages shorter than the average length of integrated applications. The shortest Medicaid/SCHIP application is only two pages long — both in Raleigh and Seattle — while New York City has the longest application, measuring ten pages in length. Not counting the application pages strictly dedicated to instructions, the average length of stand-alone Medicaid/SCHIP applications is less than four pages, which is six-and-a-half pages shorter than integrated applications. Some health insurance facilitated enrollers in New York expressed an interest in seeing the Medicaid/SCHIP simplified further to resemble the shorter disaster relief application form used after September 11, 2002.(11)

Less Information Requested from Non-Applicants

In general, Medicaid/SCHIP applications request much less information than integrated applications aboutnon-applicants' SSNs and citizenship/immigration status.(12) In the case of Seattle, for example, spaces are actually blacked-out where citizenship and immigration information is asked about the non-applicant adults and children in the household. Additionally, in the spaces where SSNs are requested of the non-applicants, there is an asterisk indicating that reporting SSNs is optional for these household members. By blacking out the spaces for citizenship/immigration status and providing the option of not reporting SSNs, the application clearly does not collect, or require, this information from non-applicants. The SCHIP application used in Arlington specifically states, "We do not need information on the citizenship status of any adults in your family" and only requests that applicant children are listed on the application. In contrast, the Medicaid/SCHIP application used in Raleigh asks for information, including SSNs, for " everyone in the home" including parents and non-applicant children and other non-applicants living in the household.

Greater Availability of Translated Application

There is greater availability of translated Medicaid/SCHIP applications in all sites compared to integrated applications. Medicaid/SCHIP applications are available in both English and Spanish in all sites. Although not available during our visit, the Spanish version of the Medicaid/SCHIP form is currently available in New York City.(13) There is also a two-page information sheet about the Medicaid/SCHIP program available in Spanish, which was available at the time of visit. In addition, translations of the SCHIP application used in Arlington are currently under construction for five other languages.(14)

The questions regarding language access and interpretation have much greater detail in the Medicaid/SCHIP applications compared to the integrated applications. For instance, there is a set of language related questions at the beginning of the Medicaid/SCHIP application used in Seattle that ask: "Do you have trouble speaking, reading or writing English? (Yes/No); Do you need materials sent to you in another language? (Yes/No); Do you need an interpreter? (If yes, we will help you through an interpreter) (Yes/No); What language do you speak?"

Exhibit 4-3:
Key Characteristics of Medicaid/SCHIP Applications in the Study Sites
Sites Programs Length Without Instructions SSN Citizenship/Immigration Status Language Access Will Not Share Information about Non-applicants with the INS
All in HH Statement on Non-applicants All in HH Statement on Non-applicants Box Translated
Medicaid/
SCHIP
Medicaid/
SCHIP
Medicaid/
SCHIP
Medicaid/
SCHIP
Medicaid/
SCHIP
Medicaid/
SCHIP
Medicaid/
SCHIP
Medicaid/
SCHIP
Medicaid/
SCHIP
Arlington, VA* Yes 4 No No No Yes No Spanish Yes
Dallas, TX Yes 2 No Yes No Yes No Spanish Yes
New York, NY Yes 8 No Yes No No Yes Spanish** No***
Raleigh, NC Yes 2 No No No No No Spanish No
Seattle, WA Yes 2 No Yes No Yes Yes Spanish Yes
Sedalia, MO Yes 2 No No No No No Spanish No
*  Prior to September 2001, there was a joint Medicaid/SCHIP application. For SCHIP, this was replaced with a new separate application. Workers and advocates reported that they were using either the TANF/FSP/Medicaid integrated application or the old Medicaid/SCHIP application for children's Medicaid-only.
**  The Spanish version of the Medicaid/SCHIP application was created in April 2001 and is currently available in New York City. At the time of the December 2001 site visit, only a one-page information sheet was available in Spanish.
***  Not explicitly stated that information will not be shared with INS, but implied.

More Information Addressing Public Charge Concerns

Compared to integrated applications, Medicaid/SCHIP applications are more likely to specifically address public charge concerns and assuage possible applicant fears about sharing information with the INS. Medicaid/SCHIP applications used in Arlington, Dallas, and Seattle contain explicit statements that information provided by applicants will not be shared with the INS. The Medicaid/SCHIP application used in Seattle contains two such explicit statements, once directly above the space that asks about citizenship and immigration information and once at the end of the application where the applicant's signature is required.

* * * * * *

Across our study sites, applications for public assistance vary considerably in length and readability. There is a striking difference between the newer Medicaid/SCHIP applications and the older integrated applications. In Medicaid/SCHIP, there has been greater attention and effort to design forms that are easily obtained through a variety of sources, short, simple to read and fill out, and cognizant of language barriers and immigrant concerns about immigration status as well as social security numbers. Collecting information necessary to determine eligibility for a variety of programs that have different eligibility requirements is inherently more difficult to accomplish through a single application form. Although some integrated applications are clearer and easier to understand than others, they are also typically longer, more difficult to fill out, and were generally designed before public charge issues had surfaced as a potential concern. However, even in the integrated application, some sites — particularly Dallas — provide explicit language about the confidentiality of information gathered by the application, such as SSNs and immigration issues that may reduce confusion or apprehension on the part of immigrants.

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Endnotes

1.  Applications described here are used statewide.

2.  Applicants submit completed applications over the Internet to the Department of Social and Health Services. After submitting the application via the Internet, applicants will have to come in to the welfare office if a face-to-face interview is necessary.

3.  North Carolina also offers an on-line, two page pre-screen for food stamps that applicants can download from the Internet.

4.  In addition to allowing a person to apply for multiple programs on the same form, integrated applications in all sites except Raleigh contain a one or two page section to apply for expedited food stamps. In Raleigh, there is a separate single-page form for expedited food stamps.

6.  Although a long established requirement for FSP, TANF and Medicaid, SSNs of applicants were not required for SCHIP eligibility determination until August 24, 2001. Our site visits occurred either prior to this new requirement or so recently afterward that we were not able to document respondent perceptions of the potential impact of this change.

7.  See the policy guidance issued by U.S. Department of Agriculture/Food and Nutrition Service, Health Care Financing Administration and U.S. Department of Health and Human Services/Administration for Children and Families to state health and human services departments in 2000 (U.S. Department of Health and Human Services and U.S. Department of Agriculture 2000).

8.  A section that appears later in the application states that pregnant women who only want Medicaid assistance are not required to submit an SSN but provides no additional clarification that non-applicants in the household are also not required to provide an SSN.

9.  The Missouri Department of Family Services has a policy explicitly requesting that eligibility workers report FSP applicants who are undocumented to the INS, although workers in Sedalia reported that they did not do this.

10.  In addition, two sites (Raleigh and Sedalia) have separate applications available to apply for food stamps only. These applications vary in terms of length, and resemble integrated applications more so than Medicaid/SCHIP applications in areas of particular relevance to immigrants and LEPs.

11.  See Chapter 3 for more detail about this special application.

12.  Stand-alone applications for Medicaid/SCHIP can focus solely on the parent(s) and children and do not need to be concerned with other members in the household because, unlike the food stamp program, the benefit is not based on household composition.

13.  A Spanish language Medicaid/SCHIP application was created in April 2001; however, there were delays in its distribution.

14.  At the time of our visit, the SCHIP form used in Arlington was being translated into Arabic, Farsi, Korean, Russian and Vietnamese.


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