Form Faa-1523a - Cash Programs Personal Responsibility Agreement (Pra)
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1
2ARIZONA DEPARTMENT OF ECONOMIC SECURITY
FAA-1523A FORFF (11 -17)
Page 1 of 2
Family Assistance Administration
CASH PROGRAMS PERSONAL RESPONSIBILITY AGREEMENT (PRA)
I understand that:
•
Cash Assistance is temporary assistance.
•
Adult family members are responsible for supporting the family.
•
Adult family members must comply with requirements to receive Cash Assistance or supportive services.
•
This agreement is in addition to the rights and responsibilities I accepted when filing my application.
Customer Requirements
I understand that to be eligible for Cash Assistance (CA), the Two-Parent Employment Program (TPEP), Tribal Temporary
Assistance for Needy Families (TANF), or Refugee Cash Assistance (RCA) all adults may be required to comply with
the following:
•
Prepare for and accept a job to support myself and my children (when children are in the home), when I do not have
an exemption or do not show good cause for not preparing for or accepting a job.
•
Make sure that all my school-age children attend school (when children are in the home).
•
Keep my children’s immunizations up to date (when children are in the home).
•
Cooperate with the CA, TPEP, Tribal TANF or RCA Programs by:
○ providing proof for eligibility
○ providing proof for possible overpayments
○ reporting changes
•
Not voluntarily quit a job without good cause.
•
Not illegally sell, possess or use a controlled substance.
Before Cash Assistance is paid, I agree to:
•
Contact the appropriate CA Work Program:
○ State Jobs Program
○ Tribal TANF work programs
○ Native Employment Work (NEW) Program
○ Private Sector work program Provider (PSP)
•
Cooperate with the Division of Child Support Services (DCSS) when a parent is not in the home.
○ For Tribal TANF and RCA, cooperation with DCSS is not a requirement.
After Cash Assistance is paid, I agree to:
•
Cooperate in all aspects of the appropriate work program.
•
Cooperate with the Division of Child Support Services (DCSS), when required.
•
Cooperate with the Child Care Administration (CCA).
I understand the following penalties:
•
CA or TPEP applications will be denied if I do not comply with DCSS (when children are in the home).
For Tribal TANF and RCA, cooperation with DCSS is not a requirement.
•
CA, Tribal TANF or the RCA Programs will be reduced or stopped if adult members of the family do not comply with
program requirements as follows:
○ CA and RCA will be reduced by 50% the first time I do not cooperate.
○ CA and RCA will stop for any additional occurrences of noncompliance, and supportive services may also stop.
○ Pascua Yaqui and Hopi Tribal TANF budgetary units have progressive sanctions of 25%, 50% and 100%.
○ Hopi TANF budgetary units include a 12 month sit out period with the 100% sanction, and are not eligible for
12 months following any additional non-cooperation occurrences.
○ TPEP payments will be withheld for one pay cycle when I do not cooperate. When three benefit cycles have been
withheld, my TPEP case will be closed.
See page 2 for USDA/EOE/ADA/LEP/GINA disclosures
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