NH DEPARTMENT OF

Department of Health and Human Services HEALTH AND HUMAN SERVICES

Bureau of Family Assistance
PO Box 181 NOTICE OF DECISION
Concord, NH 03302

September 05, 2024

***********************************************************
Aviso importante acerca de sus beneficios. Por
favor llame a la Oficina del Distrito si tiene alguna
duda o pregunta. También puede solicitar servicios
MICHELLE L PARENTEAU gratuitos de un intérprete.
1423 OLD CLAREMONT RD ***********************************************************
CHARLESTOWN NH 03603

Below is a summary of your case. The case number is 612892362. Today's action resulted in:

• Cash, Medical Coverage - No Change

• SNAP - Change

You can find out more about this action in the Summary and Details sections of this Notice.
Those sections also tell you who in your case was affected by these actions. On the last page,
there is a section called "Common Abbreviations We Use In Our Notices." It tells you what
each abbreviation we use in this Notice means.

Cash Assistance Summary

You will receive the payments shown below:

Who Gets The Payment Amount When How Often How

Michelle L Parenteau $ 13.50 09/15/2024 Twice A Month EBT

Below is the status of each person in your cash case:

Name Cash Program Begin Date Status End Date

Michelle L Parenteau APTD 04/01/2024 Open

Medical Coverage Summary

Below is the status of each person in your medical coverage case:

Name Program Begin Date Status End Date MID

Michelle L Parenteau MA 03/24/2024 Open 02011180004

Telephone: (603) 271-9700 or (844) 275-3447 (NH Only)

TDD Access: (800) 735-2964 (NH Only)
 SNAP Summary

You will receive the benefits shown below. How much you get every month might change if
something changes in your household or when you recertify for SNAP. IMPORTANT - You will
not get any SNAP benefits after the "End Date" below unless you recertify.

Who Program Amount When How Often How

Michelle L Parenteau SNAP $191.00 10/05/2024 5th of Every Month EBT

Below is the status of each person in your SNAP case:

Name Begin Date Status End Date

Michelle L Parenteau 03/01/2024 Open 02/28/2025

SPECIAL MESSAGE FOR SNAP HOUSEHOLDS

If you do not use your SNAP benefits on your EBT card for 274 days in a row, these benefits
will be removed from your EBT account. You will not be able to get these benefits back.

Even if you don't get SNAP now, if you start getting cash assistance you may be eligible for
SNAP later. Please tell us as soon as you can if you start getting cash from SSI, FANF, OAA,
APTD, or ANB.

ABAWD stands for Able-Bodied Adult Without Dependents. Any person who is aged 18
through 52, who is fit to work, and does not have a minor child in their SNAP household, is an
ABAWD and must meet certain requirements to receive SNAP benefits. If you are an ABAWD,
you must work, participate in workfare, volunteer work for an organization in your community,
or be in an approved work training program, such as a training program at your local
community college. ABAWDs must be participating in one or a combination of these activities
for at least 80 hours per month.

If you are an ABAWD and do not meet these work requirements, you can only get SNAP
benefits for 3 months in a 36-month period. After that 3-month period of not meeting ABAWD
work requirements, your SNAP benefits will end. You will not be able to get SNAP benefits
again in the same 36-month period unless you meet ABAWD work requirements or become
exempt.

YOU MUST SHOW US YOU ARE MEETING THESE ABAWD WORK REQUIREMENTS. IF
YOU DO NOT PROVE YOU ARE MEETING THESE WORK REQUIREMENTS, YOUR SNAP
BENEFITS WILL END.

See BFA Form 216 Are You An ABAWD? https://nheasy.nh.gov/forms/E/216.pdf for more information.

SNAP Employment & Training

You may be eligible to take advantage of the SNAP Employment and Training (SNAP E&T)
program. SNAP E&T is a volunteer program that can help you find work or can provide the

Case# 612892362 Page 2 of 6

training/education needed to find a better job. SNAP E&T can also help with expenses related
to participation in the program and enrollment in the SNAP E&T Program could even help you
meet ABAWD requirements!

To learn more about how SNAP E&T can help you, or to sign up today, contact an E&T
Employment Counselor by calling 603-271-9329 or emailing [email protected].

Protecting Your SNAP and Cash Benefits From Electronic Scams

Criminals are now using electronic scams like skimming and phishing to steal benefits off of
your EBT card. Skimming is a type of theft where thieves put a device on a card-swiping
machine like EBT machines, credit card machines and ATMs to copy your card information.
Phishing is where thieves use text, phone calls, or emails to pretend to be someone else to
steal your identity or card information. This information is then used to make fake EBT
cards. Those fake cards are then used to steal Cash or SNAP benefits from real accounts.

Protect your benefits:

• Never give out your personal information, EBT card number, or Personal
Identification Number (PIN) to unidentified callers, or to a link provided via text or
email. Keep your PIN a secret. Your PIN protects your information and benefits.

• Change your EBT card PIN the day before your benefits become available each
and every month. You can change your PIN by calling the EBT customer service
line at 1-888-997-9777, or by using the ebtEDGE mobile app.

• Use the “freeze” option through ebtEDGE mobile app or through ebtedge.com
when not using your EBT card.

• Review card activity carefully and frequently for any unauthorized transactions.

• If your EBT card has been compromised, request a new card by calling EBT
customer service line at 1-888-997-9777 or use the ebtEDGE mobile app.

If you become a victim of electronic stolen benefits it may be possible to replace them. Call
the Customer Service Center at 844-ASK-DHHS to report any stolen benefits.

VOTER REGISTRATION

To register to vote in New Hampshire, you must be at least eighteen (18) years old, a resident
of New Hampshire, and a U.S. citizen. Registration can only be accomplished in-person,
either at the office of your local city or town clerk at least ten (10) days before Election Day or
at your designated polling station on Election Day. To find clerk information or polling places,
visit https://app.sos.nh.gov/viphome

Explanation

The following are the reasons for the actions taken on your case:

Case# 612892362 Page 3 of 6

Program Reason
SNAP On October 1, Federal and State laws changed the Supplemental Nutrition
Assistance Program (SNAP). These included changes to income limits, the
maximum amount of SNAP benefits you can receive, and the amount of
deductions you can claim.

If you think we made a mistake: Your Right to an Administrative Appeal

("Hearing")

You can appeal our decision. For example, you can appeal if you think we made a mistake on
things like your household size, income, citizenship, immigration status, or residency. You can
also appeal what services you get or did not get or how much you get in benefits, if you think
we made a mistake in the action we took. In accordance with RSA 126-A:5, VIII, administrative
appeals are unavailable to individuals when there is an automatic change in state or federal
law adversely affecting some or all beneficiaries. If you have questions about the action we
took, please contact the Customer Service Center at 1-844-ASK-DHHS (1-844-275-3447)
and select option #3. Only call the Administrative Appeals Unit if you want to ask for an appeal.
You can contact the Appeals Unit directly at (603) 271-4292 or 1-800-852-3345 Ext 14292.
You can also write your own letter to ask for an appeal. Send your written request to the
address at the top of the first page of this Notice. You must ask for an appeal by a certain time.
The enclosed Notice of Rights and Responsibilities tells you more about when you must ask
for an appeal and what will happen at a hearing. If you are already getting benefits and you
ask for an appeal, you can also ask to keep getting the same benefits while you wait for
the decision on your appeal. If you want to do this, you must ask for your benefits to continue
within 15 days of the date on the notice of the action you are appealing.

Once you ask for an appeal, we will try to fix the problem over the phone or by meeting with
you, if we are unable to fix the problem a hearing will be scheduled. A hearing is a meeting
between you, someone from DHHS, and an appeals officer. At the hearing, you can explain
why you think we made a mistake. To get ready for your hearing, you can:

• Ask your caseworker for a copy of your file before the hearing.
• Bring someone with you to the hearing, like a friend, relative, or lawyer, or, come by
yourself.
• DHHS will not pay for the cost of any legal services you may want. However, there are
free and reduced cost legal services available in NH.
• Bring documents, information, or witnesses to show us why you think we made a
mistake.

Legal Counsel If you or anyone in your household needs free legal counsel, contact NH Legal
Aid by visiting https://nhlegalaid.org/get-help or calling 1-800-639-5290. DHHS will not pay
your legal fees.

Case# 612892362 Page 4 of 6

 SNAP Details

The budget below shows how we figured the eligibility and benefit amount for SNAP benefits
for Michelle L Parenteau.

New Old
Resource Test:
Total Resources $ 0.00 $ 0.00
Resource Limit $ 4500.00 $ 4250.00
Outcome Passed
Income Test:
Gross Earned Income $ 0.00 $ 0.00
Earned Income Disregard -$ 0.00 -$ 0.00
Gross Unearned Income +$ 943.00 +$ 943.00
Cash Grant Paid +$ 27.00 +$ 27.00
Sanction Amount +$ 0.00 +$ 0.00
Deemed Income +$ 0.00 +$ 0.00
Adjusted Gross Income =$ 970.00 =$ 970.00
Dependent Care Expenses -$ 0.00 -$ 0.00
Excess Medical Expenses -$ 0.00 -$ 0.00
Child Support Expenses -$ 0.00 -$ 0.00
Standard Deduction -$ 204.00 -$ 198.00
Adjusted Income =$ 766.00 =$ 772.00
Excess Shelter Cost -$ 430.00 -$ 414.00
Income We Counted =$ 336.00 =$ 358.00
Income Limit =$ 1255.00 =$ 1215.00
Group Size 1 1
Outcome Passed
SNAP Allotment Calculation:
Maximum SNAP Allotment =$ 292.00 =$ 291.00
30% Net Income -$ 101.00 -$ 108.00
SNAP Allotment =$ 191.00 =$ 183.00
Recoupment Amount -$ 0.00 -$ 0.00
Net SNAP Allotment =$ 191.00 =$ 183.00
NSWF Amount $ 0.00 $ 0.00

Your household may also get food and nutrition help from the Programs listed below. Your
monthly income before any deductions is $970.00. If that amount is lower than the limits
shown below, you may be eligible for additional assistance. If your household contains a
pregnant woman, a new mother or a child under 5 years old, contact WIC. If your household
contains a school age child, contact the NSLP.

Program Income Limit Contact:

Commodity Supplemental Food (CSFP) $ 1037.00 1-800-942-4321
Women, Infants and Children (WIC) $ 2322.00 1-800-942-4321
National School Lunch (NSLP) $ 2322.00 Your local school

Policy Manuals

The Explanations section of this Notice told you the reasons why we denied, stopped, or
changed your benefits. These reasons come from official guidelines called "Policy." You can
look at our Policy Manuals at any District Office or at the NH State Library in Concord, NH. You

Case# 612892362 Page 5 of 6

can also look at our Policy manuals on the World Wide Web by entering this address in your
Web browser: http://www.dhhs.nh.gov/dfa/publications.htm

The policies we used for our actions today are shown below:

Program Policy Manual Policy Part Part Name and Description

SNAP Food Stamp Manual 149 MASS CHANGES: This Part explains about
"Mass Changes." These are eligibility or benefit
changes ordered by the federal or state
government to groups of individuals.

Common Abbreviations We Use In Our Notices

We use the following abbreviations in our Notices:

ANB Aid to the Needy Blind MEAD Medicaid for Employed Adults with
APTD Aid to the Permanently and Totally Disabilities
Disabled MOAD Medicaid for Employed Older Adults with
AS Adoption Subsidy Disabilities
BCCP Breast/Cervical Cancer Program NHEP New Hampshire Employment Program
CM Children's Medicaid NSWF Nutritional Supplement for Working
EA Emergency Assistance Families
FANF Financial Assistance to Needy OAA Old Age Assistance
Families PC Parent Caretaker
FAP Family Assistance Program PNA Personal Needs Allowance Supplemental
FC Foster Care Payment
FP Family Planning QDWI Qualified Disabled and Working
FWOC Families With Older Children Individuals
Granite Granite Advantage Health Care Program QMB Qualified Medicare Beneficiary
ADV RCA Refugee Cash Assistance
HIPP Health Insurance Premium Payment SLMB Specified Low Income Medicare
Program Beneficiary
IDP Interim Disabled Parent Program SNAP Supplemental Nutrition
MA Medical Assistance (Medicaid) Assistance Program
MAGI Modified Adjusted Gross Income SSI Supplemental Security Income
TANF Temporary Assistance to Needy Families

Case# 612892362 Page 6 of 6

 NH Department of Health and Human Services (DHHS) BFA Form 810
Bureau of Family Assistance (BFA) 10/19

Notice of Rights and Responsibilities

Aviso importante sobre sus derechos y responsabilidades

Por favor lea la siguiente explicación sobre sus derechos y responsabilidades inmediatamente. El “Aviso de decisión”
incluido puede afectar su elegibilidad para continuar participando en el Programa de Cupones de Alimentos o el Programa
de Asistencia Pública o puede afectar la cantidad de la asistencia que usted puede recibir. Si su idioma principal no es
inglés o si usted tiene dificultad para entender esta información, llame a su asistente social dentro de diez días para recibir
asistencia.

If you have any questions regarding the enclosed decision, or need help in taking further action, contact your
District Office as soon as possible.
Complaints If you feel that DHHS has not given proper consideration to your household circumstances and/or you
disagree with a decision made by DHHS, you may make a complaint. Since an administrative appeal is a lengthy and time-
consuming process, you are encouraged to resolve your complaint by asking for a conference with your District Office
worker or the worker’s supervisor. You may bring a lawyer, relative, friend or anyone else to the conference with you. If you
are not satisfied with the results of the conference and still feel that your complaint is unresolved, you have the right to
request an administrative appeal.
Administrative Appeal - Food Stamp Program You or your representative must make a request for an administrative
appeal either orally or in writing within 90 days of the date on the notice of the action being appealed. If the request is
received within 15 days from the date on the notice of the action being appealed, your Food Stamp benefits may, under
certain circumstances, be continued or reinstated at the previous level until the decision on the appeal is reached or your
certification period ends. If the appeals officer agrees that our action was correct, your household will owe us the value of
the extra Food Stamp benefits you received as a result of the continued benefits. You may represent yourself or be
represented by others, including legal counsel, at the appeal.
Administrative Appeal - Other Programs You or your representative must make a request for an administrative
appeal either orally or in writing within 30 days of the date on the notice of the action being appealed. If the request is
received within 15 days from the date on the notice of the action being appealed, your assistance may, under certain
circumstances, be continued or reinstated at the previous level until the decision on the appeal is reached. If the appeals
officer agrees that our action on your assistance case was correct, your household must repay in full the extra cash, medical,
or child care assistance benefits you received as a result of the continued benefits. You may represent yourself or be
represented by others, including legal counsel, at the appeal.
Legal Counsel If you or anyone in your household needs free legal counsel, consult your telephone directory or your
District Office for the New Hampshire Legal Assistance Office nearest you. DHHS will not pay for your legal fees .
You must notify your DHHS District Office worker within 10 days of any change in your household circumstances,
such as changes in income, resources, or other financial or living arrangements. Failure to do so violates NH and
federal law and may result in losing your assistance. To report a change, contact your District Office.

To Continue Your Food Stamps

If you wish to continue receiving Food Stamp benefits when your current certification period expires, you must file a new
application. We will contact you before your benefits expire. You have the right to file an application at any time during your
last month of certification. When it is filed, the application form only needs to include your name, mailing address and the
signature of a responsible member of your household or your authorized representative. You will need to complete the rest
of the form and may be required to participate in a face-to-face interview before a decision is made to continue benefits.
If your household still qualifies, and your application is filed no later than the 15th day of the month in which your certification
expires, you will continue to receive Food Stamp benefits at about the same time each month. If you do not file a new
application on time or participate in an interview, your benefits may be late or you may not receive any more benefits after
your certification expires. If there is a delay in the application process caused by DHHS, you have the right to receive any
Food Stamp benefits you miss because of DHHS’s delay.

PLEASE BE SURE TO READ BOTH SIDES OF THIS FORM BFA SR 19-29

(NA)

CASE# 612892362
If Your Notice Says You Are Not Eligible For Medical Assistance - Please Read

You may still be able to get help with your medical bills, even if your notice says you are not eligible for medical
assistance because your income is higher than program limits. If you meet all program requirements except for income, you
can become eligible for medical assistance under the In and Out medical assistance program. To become eligible for In and
Out medical assistance, you must have medical bills that are as high or higher than your spenddown amount. Your
spenddown amount is the difference between your countable income and the program limits.

 You can choose either a 1 or 6-month spenddown amount based on your circumstances.

 Your 1 or 6 month spenddown amounts are shown on the enclosed Notice of Decision.

 You may use current or past, unpaid medical bills to meet your spenddown amount.

 If you do not have or expect enough medical bills to meet your 6-month spenddown, you might want to choose a
1-month spenddown.

Contact your District Office to see if you are eligible for In and Out medical assistance coverage. Your District Office can
explain how to qualify and how the choice of a 1 or 6 month spenddown amount would affect you .

Time Limits on Benefits

Adults receiving cash assistance benefits under Financial Assistance to Needy Families (FANF) can only get these cash
benefits for 60 months in a lifetime, unless the family is experiencing a hardship at the time the 60 months is up. For more
information on the 60-month lifetime limit, contact your District Office or NHEP worker.

There is no time limit on Food Stamps, child care assistance, Medicaid (including those programs that help pay
Medicare expenses), or any of our cash programs for the elderly, the blind, or the permanently disabled. You can
keep getting these benefits for as long as you remain eligible.

Information About Resources

Most assistance programs have limits on the amount and kinds of resources you can have and still be eligible. Resources
are things of value that you have or own, such as bank accounts, investments, cars, or property. Each program has different
rules for what kinds of resources we count, and how we determine the value of each resource. If the assistance program
you want has a resource limit, you may get a separate letter from your District Office worker if we need more information
about your resources.

Child Care Services

If you are working, looking for work, in school or in training, and use or need child care services, your District Office may be
able to help pay for child care costs. You will need to complete an application and meet income guidelines to get this help.
Contact your local District Office to apply for assistance in paying for child care, and your local child care resource and
referral agency for information on finding child care providers. The District Office will have contact information for the child
care resource and referral agency.

Family Planning Services

Under federal law, the Department of Health and Human Services is required to inform you of the availability of family
planning services. Family planning services include counseling, medical examinations, and contraceptive supplies. Such
services are available throughout the state. If you meet certain requirements, you may be eligible for these services at no
cost. If you or any members of your family are interested in family planning services, please contact your District Office for
further information.

This institution is an equal opportunity provider.