Model Local Welfare Guidelines

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2021 Model Local Welfare Guidelines Cover, Sunrise and Lighthouse
Publication Date: 
Monday, June 7, 2021

Table of Contents



  1. Severability

III. Confidentiality of Information

  1. Roles of Local Roles of Local Governing Body and Welfare Official
  2. Maintenance of Records
  3. Application Process

VII. Verification of Information

VIII. Disbursements

  1. Determination of Eligibility and Amount
  2. Non-Residents
  3. Municipal Work Programs

XII. Burials and Cremations

XIII. Right to Notice of Adverse Action

XIV. Fair Hearings

  1. Liens

XVI. Recovery of Assistance

XVII. Application of Rents Paid by the Municipality

Appendix A: Allowable Levels of Assistance Payments

Appendix B: Explanation for Disqualification for Noncompliance with Guidelines

Appendix C: Adopted Ethics Resolution on Responsibility for Persons Who Change

Their Residence While, or As a Result of, Applying for Local Welfare

Appendix D: New Hampshire Welfare Benefit Programs

Appendix E: Forms

Form A: Application for Assistance

Form B: Authorization for the Release of Information – DHHS

Form C: Notice of Rights of Anyone Receiving Assistance

Form D: Applicant’s Authorization to Furnish Information

Form E: Applicant’s Authorization to Furnish Information

(Specific Agency/Individual).

Form F: Required Verifications

Form G: Intake Form

Form H: Municipal Welfare Department Medical Release and Report

Form I: Employment Verification Form

Form J: Rental Verification Form

Form K: Budget Worksheet

Form L: Notice of Decision

Form M: Workfare Program Reporting Form

Form N: Employment Search Record.

Form O: Fair Hearing Request

Form P: Notice of Fair Hearing

Form Q: Fair Hearing Decision

Form R: Notice of Property Lien

Form S: Notice of Property Lien Discharge

Form T: Rent Voucher – Landlord Delinquency

Form U: Update Application Form

Form V: Basic Need Policy