Form Sna-1000a - Rights And Responsibilities
Download a blank fillable Form Sna-1000a - Rights And Responsibilities in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Sna-1000a - Rights And Responsibilities with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2SNA-1000A FORPD (12-17)
ARIZONA DEPARTMENT OF ECONOMIC SECURITY
Workforce Development Administration
Supplemental Nutrition Assistance Employment and Training (SNA E&T) Program
RIGHTS AND RESPONSIBILITIES
The purpose of the SNA E&T Program is to help you become economically independent. In order to reach this goal, you must prepare
for, obtain and retain a job.
PARTICIPANT'S NAME (Last, First, M.I.)
AZTECS CASE NO.
JAS ID NO.
PARTICIPANT RIGHTS AND RESPONSIBILITIES
I have the following right and/or responsibility to:
1.
Prepare for and obtain employment to support myself and my family as soon as possible.
2.
Attend scheduled appointments with the SNA E&T Program. If I fail to do so without a good reason, my Supplemental Nutrition
Assistance Program Benefits could be cut or stopped.
3.
Complete required assessments that will help the SNA E&T Program assist me in developing an Employment and Career
Development Plan (ECDP) to help me become economically independent.
4.
Be involved in developing my ECDP.
5.
Participate in activities indentified on my ECDP. If I fail to do so without a good reason, my Supplemental Nutrition Assistance
Program Benefits could be cut or stopped.
6.
Tell SNA E&T Program staff if I have any problems preventing my participation with the SNA E&T Program requirements.
7.
Tell SNA E&T Program staff when I will be absent from an appointment or activity identified on my ECDP and be prepared to
submit proof that verifies a good reason for not participating. I will request help from my SNA E&T Specialist if I have trouble
getting proof.
8.
Have information in my case record kept confidential.
9.
Request help from the SNA E&T Program Specialist and/or supervisor if I do not agree with my ECDP or believe I have been
treated unfairly or discriminated against by any SNA E&T Program staff member.
10.
Request help from the Workforce Administration (WA) Client Advocate when I believe my concerns have not been resolved
through the SNA E&T Program Specialist and/or supervisor. I can request help from the WA Client Advocate using any of the
following methods.
Email:
EAClientAdvocate@azdes.gov
Phone:
602-771-1307 or Toll free 1-877-371-1307
Fax:
602-277-0568
Mail:
Arizona Department of Economic Security
WA Client Advocacy – Mail Drop 5275
P.O. Box 6123
Phoenix, AZ 85005-6123
11.
Request a Fair Hearing if I believe my Nutrition Assistance benefits have been cut or stopped unfairly.
12.
Notify the SNA E&T Specialist if I receive an allowance for transportation or training expenses from other programs.
13.
Report changes such as a job, new address and new telephone number the SNA E&T Program.
SNA E&T PROGRAM RIGHTS AND RESPONSIBILITIES
The Arizona Department of Economic Security (DES) SNA E&T Program agrees to:
1.
Use information you share to develop an ECDP that is the most effective in helping you become economically independent while
staying within federal guidelines.
2.
Help you find solutions to issues.
3.
Provide information on child care, medical assistance and other employment-related services.
4.
Reassess and change your ECDP when needed.
5.
Treat you with dignity and respect
6.
Keep personal information confidential and give information, only when needed, to approved providers, contractors, other DES
administrations or as required by law.
My rights and responsibilities have been explained to me and I fully understand them. I also understand that my SNA Program Benefits
could be cut or stopped if I fail to meet the requirements of my ECDP.
PARTICIPANT'S SIGNATURE
DATE
As a representative of the DES SNA E&T Program, I have carefully explained the above rights and responsibilities.
SNA E&T SPECIALIST’S SIGNATURE
DATE
Routing: Original - Case file; Copy – Participant
See reverse for EOE/ADA/LEP/GINA disclosure.
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Wh-381 - Notice Of Eligibility And Rights And Responsibilities (family And Medical Leave) - U.s. Department Of Labor - 2013
Business
Form Wh-381 - Notice Of Eligibility And Rights And Responsibilities (family And Medical Leave Act)
Business
Form Fmla-hr2a - Notice Of Eligibility And Rights And Responsibilities - State Of Connecticut Human Resources
Business
Related Categories
Parent category: Legal