Chapter 5: Application

5.1 Overview

This chapter explains the application process, which includes determining whether the CRS program is the appropriate resource, collecting demographic information, collecting financial information, collecting needed medical documentation, and following the procedures to get a PIN.

5.2 Scheduling the Application Appointment

When scheduling an appointment for a consumer to apply for services, determine the consumer's language preference and decide whether the consumer needs a translator, interpreter services for the deaf, reasonable accommodations, and/or assignment to a specialty caseload.

The CRS program provides language services if necessary to ensure that all consumers have meaningful access to programs, services, and information.

Language services are provided at no cost to the consumer and may include:

  • spoken interpretation (over-the-phone and face-to-face);
  • written translation; and
  • sign language interpretation.

CRS program staff members must assist consumers who require language services by:

  • determining the type, amount, and cost of the language services;
  • getting approval to provide the services;
  • submitting a service authorization; and
  • documenting the need and details about the consumer’s use of the service in the consumer record. 

Additional information on how to access language services can be found at HHS Circular C-013, Health and Human Services System Language Services Policy.

Use DARS5003, Application Appointment Letter in ReHabWorks (RHW) to schedule the appointment. For instructions, see RHW Users Guide, Chapter 5 Initial Contact, 5.5 Initial Appointment. (DARS5003 is available only in RHW).

Ask the consumer to bring appropriate records to the application appointment, including:

  • a photo ID, such as driver's license, state issued ID, school ID, passport, or military ID;
  • an original Social Security card or other proof of identification, as explained in 5.3 Identification;
  • the names and addresses of two people who know how to contact the consumer;
  • the dates of medical treatment and the medical providers’ names, addresses, and phone numbers;
  • the consumer’s rehabilitation history;
  • a list of agencies from which the consumer has received services, by the time of application);
  • proof of income for the consumer and the consumer's spouse (or the consumer's parents, if the parents claim the consumer as a dependent on their federal income tax), such as copies of the latest pay stub, proof of Supplemental Security Income, proof of Social Security Disability Income, a U.S. Department of Veterans Affairs award letter, or a workers' compensation Notice of Payment;
  • proof of expenses related to monthly mortgage or rental payments, prescribed diets and medicines, debts imposed by court order, and medical costs and other disability related expenses;
  • proof of medical insurance, including Medicaid and Medicare; and
  • other items that may help with the application and eligibility process.
 

5.3 Identification

The consumer is to provide original documents that establish that the consumer is either a resident or permanent legal resident of Texas and the United States.

The consumer must present one original, unexpired document from Column A or one each from Column B and C when applying for services.

Original Documents to Be Provided by the Consumer

Column A

Column B

Column C

  • U.S. Passport or U.S. Passport Card
  • Foreign passport that contains a temporary I-551 stamp or temporary I-551 printed notation on a machine-readable immigrant visa
  • Permanent Resident Card or Alien Registration Receipt Card (INS Form I-551)
  • Employment Authorization Card that contains a photograph (Form I-766)
  • For nonimmigrants authorized to work for a specific employer: a foreign passport with an Arrival-Departure Record, Form I-94 or I-94A, bearing the same name as the passport and containing an unexpired endorsement of the individual's nonimmigrant status.
  • Passport from the Federated States of Micronesia (FSM) or the Republic of the Marshall Islands (RMI) with Form I-94 or Form I-94A, indicating nonimmigrant admission under the compact of Free Association between the United States and the FSM or RMI.
  • Driver's license or ID card issued by a state or outlying possession of the United States provided it contains a photograph or information such as name, date of birth, sex, height, eye color, and address
  • ID card issued by federal, state or local government agencies or entities provided it contains a photograph or information such as name, date of birth, sex, height, eye color, and address
  • School ID card with a photograph
  • Voter's registration card
  • U.S. Military card or draft record
  • Military dependent's ID card
  • U.S. Coast Guard Merchant Mariner Card
  • Native American tribal document
  • Driver's license issued by a Canadian government authority
  • For persons under age 18 who are unable to present a document listed above:
  • School record or report card
  • Clinic, doctor, or hospital record
  • Day-care or nursery school record.
  • Social Security Account Number card other than a card stating it is not valid for employment
  • Certification of Birth Abroad issued by the Department of State (Form FS-545)
  • Certification of Report of Birth issued by the Department of State (Form DS-1350)
  • Original or certified copy of a birth certificate issued by a state, county, municipal authority, or outlying possession of the United States bearing an official seal
  • Native American tribal document
  • U.S. Citizen ID Card (Form I-197)
  • ID Card for use of Resident Citizen in the United States (Form I-179)
  • Employment authorization document issued by the Department of Homeland Security.

Even if the consumer does not have the documents listed in this section:

  • allow the consumer to complete the application; and
  • explain that the documents are required before the CRS program can determine the consumer’s eligibility for services.

If the consumer has the documents, examine the documents presented. Expired documents cannot be accepted. If the documents are not expired, but will expire in the near future, counsel the consumer about the importance of keeping the documents up to date.

Place a copy of each document provided in the consumer’s case file. If the consumer is reluctant to allow you to make copies of the documents, or if you do not have immediate access to a copy machine, enter the following in a case note in ReHabWorks for each document examined:

  • The document’s title
  • The issuing authority
  • The document’s number (for example, a form number or driver’s license number)
  • The expiration date of the document

5.4 Voter Registration Requirements

A CRS program staff member offers the consumer the opportunity to register to vote at the time of application for services or when the consumer reports a change of address.

A CRS program staff member is prohibited from:

  1. influencing a consumer’s political preference or party registration;
  2. displaying political preference or party affiliation; or
  3. making any statement or taking any action to discourage a consumer from registering to vote.

5.5 Completing the Application

The application must be completed in a private location that maintains the confidentiality of the information provided by the consumer.

Explain to the consumer the circumstances under which information about him or her will not be kept confidential. For example, confidential records are released “… to prevent imminent harm to you [the consumer] or someone else.”

Explain to the consumer that if the consumer says that he or she plans to hurt someone or has hurt someone, you must report it to the authorities. This requirement to report includes situations involving child abuse and abuse of the elderly.

Fill out the consumer’s application in ReHabWorks (RHW). For instructions, see RHW Users Guide, Chapter 10 Application.

When RHW is not available, apply by using DARS5056, DRS Application for Services and DARS5059, DRS Application Statement—CRS .

Ensure that all information entered in the application is accurate.

5.6 Types of Income, Liquid Assets, and Required Proof

The table below lists the types of income and corresponding proof required of the consumer, spouse, and parents (if the consumer is claimed as a dependent).

Table: Types of Income, Liquid Assets, and Required Proof

Income

Proof Required

Net wages and net income from other enterprises

  • pay verification;
  • check stubs;
  • bank statements; or
  • earnings statement.

Social Security disability benefits (Supplemental Security Income (SSI) or Social Security Disability Income (SSDI)) received by consumer

None required for a consumer's Social Security disability benefits.

All other Social Security benefits (for example, survivor or retirement benefits received by consumer or the consumer's spouse or parents, or Social Security disability received by consumer's spouse or parents)

  • award letter;
  • check stub;
  • income tax return; or
  • bank statement.

Income from other sources, such as public support payments, unemployment compensation income, Workers' Compensation income, private disability insurance, annuities

  • award letter;
  • check stub;
  • income tax return; or
  • bank statement.

Child support payments

  • award letter;
  • check stub;
  • income tax return;
  • court order; or
  • bank statement.

Liquid assets, such as cash and assets from savings or other accounts.

Account statements

5.7 Basic Living Requirements (BLR)

5.7.1 Calculating Consumer Participation

ReHabWorks (RHW) is designed to automatically calculate the amount a consumer must contribute toward the cost of services. The cost is based on 200 percent of the federal poverty guidelines issued by the U.S. Department of Health and Human Services and the information that you enter into RHW about the consumer's income, family status, and economic need. See the guidelines for the state’s latest fiscal year.

Table: BLR Table (as of March 2016)

*Based on for 2016 Health and Human Services Federal Poverty Guidelines

Number of Dependents Supported by Net Income or Liquid Assets

Monthly Net Income Level

Liquid Assets Level

1

$1,980

$13,860

2

$2,670

$18,690

3

$3,360

$23,520

4

$4,050

$28,350

5

$4,740

$33,180

6

$5,430

$38,010

7

$6,122

$42,854

8

$6,815

$47,705

9

$7,508

$52,556

10

$8,202

$5,7414

11

$8,895

$62,265

12

$9,588

$67,116

13

$10,282

$71,974

14

$10,975

$76,825

15

$11,668

$81,676

16

$12,362

$86,534

17

$13,055

$91,385

18

$13,748

$96,236

19

$14,442

$101,094

20

$15,135

$105,945

*The BLR table is based on the federal poverty guidelines issued by the U.S. Department of Health and Human Services. The table is updated each year to reflect annual adjustments.

RHW uses net monthly income and family size as they relate to the poverty guidelines for the state’s current fiscal year to determine the amount a consumer must contribute to the cost of services. The amount is paid monthly, but is applied only when a consumer receives goods and services that require a contribution.

5.7.2 Allowable Additions to Basic Living Requirements

The total monthly costs of the allowable additions listed below are automatically added to the Basic Living Requirements (BLR) table when a new case is entered in ReHabWorks.

Table: Allowable Additions to BLR

Allowable Additions

Proof Required

Monthly home mortgage or rental payments

Statement;

Canceled check;

Money order stub;

Contract; or

Lease, etc.

Prescribed diets and medicines used by the consumer

Itemized receipts; or

Canceled checks

Debts imposed by court order

Court record

Medical costs and disability-related expenses

Itemized statements; or

Canceled checks

5.8 Selecting Disability Information

Disabling conditions are classified according to a structure that combines impairment with a specific cause or source. Using prescribed categories, select the impairment and then select the cause or source that best describes the consumer's primary disability; that is, the physical or mental impairment that results in a substantial impediment to the rehabilitation goals in the CRS program.

To select the disability code:

  1. select the impairment category table that best identifies the disability; that is:
    • sensory-communicative;
    • physical; or
    • mental;
  2. select the specific impairment subcategory within the table, such as:
    • cognitive impairments-learning, thinking, processing/concentration;
    • other mental; or
    • psychosocial impairments-interpersonal/behavioral, difficulty coping; and
  3. select the specific cause or source of the disabling condition in the cause or source table, such as:
    • traumatic spinal cord injury; or
    • traumatic brain injury.

Using the same sequence of actions, you select the secondary impairment that contributes to, but is not the primary basis of, the impediment to the consumer’s rehabilitation goals.

*If this information is not available at the time of application, it must be completed at the time of eligibility determination.

5.9 Application Statements

Before the application is signed, discuss with the consumer:

  • the purpose and expectations of the CRS program;
  • the roles and participation of the counselor and consumer throughout the CRS process; and
  • the consumer's role in making informed choices when choosing a rehabilitation goal, services, service providers, and application statement.

Provide a copy of the application statement to the consumer.

Approval by the counselor and signed approval by the consumer or the consumer's representative verify that the consumer was given the information.

If a consumer’s representative is signing the application statement for the consumer, explain to the consumer that information in his or her case file will be made available to the representative. For more information, see the chart below concerning representative types.

Although the consumer may choose whomever he or she wants as a representative, inform the consumer that you will not purchase goods or services from a provider who serves as his or her representative because of the conflict of interest.

Table: Representative Types and the Requirements for Case File Documentation.

Representative Type

Documentation Required for the Paper Case File

The consumer’s representative

  • A completed DARS1487, Designation of Applicant or Consumer Representative;
  • Proof showing the power of attorney; or
  • A statement written by the consumer designating a representative

The consumer’s court appointed guardian or representative

Current legal documentation showing proof of guardianship or representation

5.10 Application Signatures

Record the application signature in ReHabWorks (RHW). When RHW is not available, use DARS5059, DRS Application Statement—CRS, to record the application signature.

The consumer signs the application electronically by using a personal identification

5.10.1 Assigning a PIN

When you enter a consumer’s contact information in ReHabWorks (RHW) during initial contact, RHW automatically assigns the last four digits of the consumer's Social Security number (SSN) as a temporary PIN. During the application phase, or at any time that the PIN is reset, the consumer must choose a new PIN to replace the temporary PIN.

The consumer, or the consumer’s parent, guardian, or representative, chooses and enters a four-digit PIN as a signature of authorization on the application and all other electronic documents that require a signature of authorization (for example, the application and the consumer’s Individualized Written Rehabilitation Plan).

Encourage the consumer to use a number that is easy to remember. Do not record the PIN in the case note; instead, encourage the consumer or the consumer’s representative to record the PIN and keep it for reference.

5.10.2 When a Consumer Cannot Remember the PIN

If the consumer cannot remember his or her PIN and ReHabWorks (RHW) is available:

  1. contact the manager or the manager's designee to reset the PIN to the last four digits of the consumer’s Social Security number and document the reason for resetting the PIN in a case note; and
  2. have the consumer reset the PIN to a new number.

To learn how to reset a PIN for a consumer or the consumer’s representative, parent, or guardian, refer to the RHW Users Guide, Chapter 8 PINS.

5.10.3 The Parent’s or Guardian’s Signature

The signature or PIN of a parent or guardian is required when the consumer is:

  • a minor (under 18 years of age); or
  • legally incompetent and assigned a legal guardian.

Note: Usually a foster parent is not the legal guardian for his or her foster child and cannot sign an application for services, releases, or the consumer’s Individualized Written Rehabilitation Plan on behalf of the child. The child's managing conservator has the legal authority to sign these documents. Locate the conservator through the Texas Department of Family and Protective Services. A person under 18 years of age and legally married is not considered a minor under Texas law.

5.10.4 A Consumer Representative’s Signature

A consumer may designate someone as his or her representative for all or part of the rehabilitation process. The representative may be authorized to sign documents, speak on the consumer's behalf, or serve in other capacities indicated on DARS1487, Designation of Applicant or Consumer Representative. In some cases, a representative can play an important role in facilitating communication and helping the consumer meet his or her rehabilitation outcome.

5.11 When CRS Program Staff Members May Enter a PIN on Behalf of a Consumer

There are only three circumstances when CRS program staff members may enter a PIN on behalf of a consumer or the consumer’s parent, guardian, or representative; that is, when:

  1. ReHabWorks is not available;
  2. the consumer is not present; or
  3. the consumer cannot physically enter a PIN.

In any of these instances, follow the procedures outlined below.

ReHabWorks Is Not Available

When ReHabWorks (RHW) is not available, do as follows:

  1. Print one of the following forms or any other applicable forms, fill out the form, and ask the consumer to sign it:
    • DARS5059, DRS Application Statement—CRS
    • DARS5164, DRS Individualized Written Rehabilitation Plan (IWRP)—CRS
    • DARS5160, DRS Individualized Written Rehabilitation Plan (IWRP) Amendment—CRS
  2. Tell the consumer that a temporary PIN will be used to enter the information from the application into RHW as soon as possible.
  3. Create a temporary PIN as soon as you have access to RHW, by using one of the following two procedures:
    • If the consumer has already set his or her PIN, have the manager or the manager's designee:
      • reset the PIN to the last four digits of the consumer's Social Security number (SSN); and
      • document the action in a case note; or
    • If the consumer has not already set his or her PIN, you can sign the document for the consumer by using the last four digits of the consumer's SSN.
  4. Enter the information from the signed paper form into RHW, and enter the temporary PIN to sign the electronic form.
  5. Document the use of the temporary PIN and the reason for it in a case note.
  6. Keep the signed paper forms in the paper case file, even after recording the information in RHW.
  7. Have the consumer reset the PIN on his or her next visit, when RHW is available.

Consumer Is Not Present

If the consumer is not present and with the consumer's permission:

  1. contact the manager or the manager's designee to:
    • independently verify permission directly with the consumer;
    • reset the PIN to the last four digits of the consumer's SSN;
    • document the reason for resetting the PIN in a case note;
  2. when the consumer is present and RHW is available:
    • have the consumer reset the PIN to a new number; and
    • document the action in a case note.

Consumer Cannot Physically Enter the PIN

When a consumer cannot physically enter a PIN:

  1. enter a PIN for the consumer;
  2. have the action witnessed; and
  3. enter the witness's name in RHW, in the appropriate space.

5.12 Forms to Be Signed at Application

The following forms, in addition to the application, are signed to permit the exchange of information needed during the rehabilitation process:

  1. and, DARS5061, Notice and Consent for Disclosure of Personal Information, and when a specific need is identified, a current DARS5060, Permission to Collect Information; and
  2. DARS1517-2, Authorization for Release of Confidential Consumer Records and Information, when needed to release specific information in accordance with Business Procedures Manual, Chapter 20: Confidentiality and Use of Consumer Records and Information.

File the signed forms in the consumer's case file.