PENALTY REQUEST TO IMPOSE/END/DELETE CLNO/CANO FORMAT
CLNO/CANO Title: WA Penalty – Request to Impose or
SS Penalty – Request to Impose
Note: A WA penalty is imposed for failure to complete activities on the FSSP. Exempt clients can receive a WA penalty for not completing self-sufficiency activities, but not work related activities. In a 2P family, include the client’s first name at the end of the CANO title. Example: WA Penalty - Request to Impose – Sally
CLNO/CANO Body:
DATE OF FSSP THAT LISTS THE WORK ACTIVITY ASSIGNED:
ACTIVITY(S) NOT DONE:
ATTEMPTS TO DETERMINE GOOD CAUSE (phone call, letter, dates/times):
REASON CLIENT GAVE FOR NON-COMPLIANCE:
ACTIVITES TO BE COMPLETED TO END/DELETE PENALTY (if different than above):
CM ACTIONS: Entered CLNO, CANO, and send an email to the assigned Eligibility office. Link to office listing: http://dpaweb.hss.state.ak.us/FIELD/PDF/DPA_Offices-Functional-Teams-Email-Fax.pdf
CLNO/CANO Title: WA Penalty Request to End or Delete or
SS Penalty Request to End or Delete
Note: if compliance did not begin within 10 days of intent a new date of intent must be established. In a 2P family, include the client’s first name at the end of the CANO title. Example: WA Penalty - Request to End – Sally
CLNO/CANO Body:
ACTIVITIES COMPLETED & DATE COMPLETED (or date of good cause/exempt):
DATE CLIENT CONTACTED OFFICE WITH INTENT TO PARTICIPATE:
REQEUST TO END/DELETE PENALTY BACK TO DATE OF INTENT:
CM ACTIONS: Entered CLNO, CANO, and send an email to the assigned Eligibility office. Link to office listing: http://dpaweb.hss.state.ak.us/FIELD/PDF/DPA_Offices-Functional-Teams-Email-Fax.pdf
CLNO/CANO Title: WA Penalty – Alternate Activity to End
Note: if compliance did not begin within 10 days of intent a new date of intent must be established. In a 2P family, include the client’s first name at the end of the CANO title. Example: WA Penalty – Alternate Activity to End – Sally
CLNO/CANO Body:
DATE PENALTY BEGAN:
PENALTY WAS IMPOSED BECAUSE THESE ACTIVITIES WERE NOT COMPLETED:
ALTERNATE ACTIVITES ASSIGNED TO END/DELETE PENALTY:
HOW/WHEN CLIENT WAS ADVISED OF THE NEW ACTIVITIES TO COMPLETE:
CM ACTIONS: Entered CLNO, CANO, and send an email to the assigned Eligibility office. Link to office listing: http://dpaweb.hss.state.ak.us/FIELD/PDF/DPA_Offices-Functional-Teams-Email-Fax.pdf
DPAWS Field Services Page 1 of 2 April 2017