PURPOSE: To provide a statement signed by a parent or sighted spouse of an Supplemental Aid to the Blind or Blind Pension applicant or recipient, whether living in the same household with the claimant or living elsewhere, which will provide information regarding ability to support the claimant and which will be used by the County Family Support Division office to determine eligibility on this factor. The statements on the form do not require verification.
NUMBER OF COPIES AND DISTRIBUTION: Make two copies. Give the form to the sighted spouse or parent if interviewed during the course of investigation. Otherwise, mail it to him/her and enclose a return envelope. File the completed, signed, form permanently in the IM section of the case file.
MANUAL REFERENCE: Chapter III and Chapter IV
INSTRUCTIONS FOR COMPLETION:
CASE NAME: The worker enters the case name of the claimant.
CASE DCN: The worker enters the Departmental Client Number (DCN) of the claimant.
DATE: The worker enters the date the form is completed.
The parent or sighted spouse makes the remaining entries. Give or mail the form to each person who is a parent or sighted spouse of the claimant. If both parents are living in the same home, they may complete one form jointly with both parents signing the one form. A sighted spouse is defined as one who does not meet the definition for blindness as contained in the Aid to the Blind law.
Unless the circumstances of the signed spouse or parent are known to the county Family Support Division office (for example, receiving another form of assistance, etc.), obtain form IM-2B at each reinvestigation.
Upon receipt of the completed form, use the information as follows: