Reasonable Modifications and Communication Assistance Request Form
ADA/Section 504 and Civil Rights
Notice of Nondiscrimination in DFCS programs, services and activities:
The Georgia Division of Family & Children Services (DFCS) is prohibited from discriminating on the basis of race, color, national origin, disability, age, sex and in some cases religion or political beliefs.
The U.S. Department of Agriculture also prohibits discrimination based on race, color, national origin, sex, religious creed, disability, age, political beliefs or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA.
Read our full Notice of ADA/Section 504 Rights and the joint U.S. Department of Agriculture and U.S. Department of Health and Human Services’ Notice of Nondiscrimination, below:
Customers with Disabilities: Requesting a Reasonable Modification and Communication Assistance
Qualified individuals with a disability have a right to request and DFCS must provide Reasonable Modifications when the modifications are necessary to avoid discrimination based on disability. For example, we may change policies, practices, or procedures to provide equal access. Examples of Reasonable Modifications may include but are not limited to face-to-face interviews and telephonic signatures (if applicable). To ensure equally effective communication, we provide persons with disabilities or their companions with disabilities communication assistance, such as sign language interpreters. Our help is free. DFCS is not required to make any modification that would result in a fundamental alteration in the nature of a service, program or activity or in undue financial and administrative burdens.
Learn more about how to request a Reasonable Modification and Communication Assistance.
Reasonable Modifications and Communication Assistance Request Form
To print a Reasonable Modification or Communication Assistance form, click an option below:
Requests for Reasonable Modification and Communication Assistance can be emailed to firstname.lastname@example.org.
All eligibility workers have the responsibility and authority to offer, grant, and implement necessary reasonable modifications to customers with disabilities if they can be readily provided. Common examples of reasonable modifications and communication assistance but not all, include: help filling out and explaining applications and re-certification forms for benefits, help gathering documents required by the program to support initial and ongoing eligibility for benefits, and providing notices, applications, re-certifications, and other program materials in alternate formats (e.g., Braille, data format, audio CD, large print, etc.), to customers with visual or hearing impairments.
Considerations of and decisions concerning a customer’s request for reasonable modification may incorporate the following factors, assessed cooperatively with the customer: How the disability limits the customer’s ability to comply with program eligibility procedures, reasonable modification options that address those limitations; and the effectiveness and feasibility of the proposed options. Provisions of reasonable modifications are based on a fact-specific inquiry that is to be assessed on a case-by-case basis. Once your Request for Reasonable Modification and Communication Assistance is received, it is reviewed by a staff member. If a staff member has questions or if the requested Reasonable Modification or Communication Assistance needs further explanation or clarification, the staff member will contact you using the information you provided.
If you need help communicating with us in a language other than English, ask us or call 1-877-423-4746. Our services, including interpreters, are free. If you are deaf, hard-of-hearing, deaf-blind or have difficulty speaking, you can call us at the number above by dialing 711 (Georgia Relay).
For a complete list of DFCS ADA/Section 504 District and Regional Coordinators, including the Statewide Senior SNAP and RSM Coordinators, and the DFCS ADA/Section 504 Statewide Coordinator,.
For large print versions of DFCS applications, renewals, and other program materials visit https://dfcs.georgia.gov/food-stamps.
To request an alternate format other than large print, contact your caseworker or complete a Reasonable Modification and Communication Assistance Request Form
DFCS Discrimination Complaint Procedures & Form
- What kinds of Reasonable Modifications may be provided for help accessing programs and services? Preference will be given to your request that you identify to help you access the services. For example, if you have an intellectual disability and you need help understanding forms that need to be completed to determine eligibility for benefits, our staff can provide help. If you have a disability that limits your ability to complete the forms that determine eligibility, we can assist with that. If you have ADHD and need a reminder of an upcoming appointment, we can provide that. If you need communication assistance and request application forms and other vital documents in alternative formats, such as Braille, we can provide that. If you are Deaf and need a sign language interpreter, we will provide one. Reasonable Modifications are not the same as the programs for which you might apply. For example, asking for Medicaid itself is not considered a Reasonable Modification, but any aid or service that would allow you to participate in the Medicaid eligibility process may be considered a Reasonable Modification.
- Is my local DFCS office accessible for my wheelchair? Yes. To schedule an appointment, please contact your DFCS district or regional ADA/Section 504 Coordinator. Is there a hardship waiver where I can skip parts of the program eligibility process due to my disability? All applicants must satisfy the individual program requirements in order to be determined eligible. DFCS cannot approve policy requirements set forth by outside agencies who determine policy requirements. This would mean if a Reasonable Modification is requested for a policy requirement for Medicaid, an applicant would be directed to request the modification from the Georgia Department of Community Health, the organization that administers the Medicaid program. If a request for a waiver of policy requirement for Food Stamps is received, the applicant would be referred to the United States Department of Agriculture, Food and Nutrition Services, the organization that determines eligibility requirements. If you need assistance in meeting a policy requirement, such as obtaining verification, please speak to your case worker about any modifications that can be made.
Questions specific to Food Stamps (SNAP):
- Can I deduct shelter expenses from my income to qualify for Food Stamps? Households are allowed a shelter deduction for shelter expenses they are billed for. Monthly shelter expenses that are more than 50% of the household’s income after all other SNAP deductions are allowed may be deducted. The excess shelter amount is $569 per month for SNAP households unless there is a household member in the SNAP case who is elderly (60 years old and older) or disabled (receiving Social Security Disability, SSI or other Disability Income as defined by SNAP). Elderly or disabled households are able to deduct the full excess shelter amount as a deduction.
- Can I deduct medical expenses from my income to qualify for Food Stamps (SNAP)? Individuals who are elderly (60 years and older) or disabled (receiving Social Security Disability, SSI or other Disability Income as defined by SNAP) are allowed a medical deduction for medical expenses they are billed for. Medical expenses that are more than $35 per month may be deducted from the household’s income. Elderly or disabled individuals who have more than $35 per month in out of pocket medical expenses may be eligible to receive the standard medical deduction. The standard medical deduction amount is $136. The amount allowed as a medical deduction is $101 ($136-$35 exclusion). Elderly or disabled individuals who have more than $136 per month in out of pocket expenses may be eligible to claim a higher medical deduction amount. These households must provide proof of their medical expenses to receive the deduction.
Questions specific to Medical Assistance:
- Can I deduct shelter expenses from my income to qualify for Medicaid? There are several medical assistance programs in Georgia. Available deductions depend upon the type of medical assistance program for which you apply.
- Can I deduct medical expenses to qualify for Medicaid? There are several medical assistance programs in Georgia. Available deductions depend upon the type of medical assistance program for which you apply.
- What Medicaid services or benefits would my disability exclude me from receiving or participating in? None. Your disability will not exclude you from receiving or participating in a Medicaid class of assistance.
- Are reasonable modifications for my disability extended from third party entities of the state as it relates to Medicaid? Yes. Any third-party entities involved in an interaction with the customer have guidelines set to address Reasonable Modifications. A common entity that may require contact with the customer is the care management organization (CMO) that partners with Medicaid and coordinates care services for certain Medical Assistance programs. These CMOs include WellCare, Amerigroup, CareSource, and Peach State Health. Modifications for customers, upon request to the CMO, may include TTY/TDY services for phone calls, language assistance, large print, Braille, audio assistance---please call your CMO Member Services phone number to inquire.
Questions specific to Temporary Assistance to Needy Families (TANF):
- If I have a physical or mental disability, can I apply for TANF assistance? An individual with a disability has a legal right to equal access to all TANF benefits and services for which they are eligible. All individuals must have an opportunity to participate in and benefit from DFCS programs and services equal to those provided to an individual with no disabilities.
- I have a disability and I am unable to work. What verification do I need to be eligible for TANF? Once a customer is interviewed and discloses a disability, Form 806, Medical Statement is given to the customer along with a checklist of items to be returned. Form 806 is used to get information from a medical provider to document the extent to which a customer’s medical condition affects his or her ability to function in everyday activities and/or engage in work activities. Once the form has been completed by the customer’s physician explaining what the customer can do, an assessment is completed, and the customer is assigned to a work activity based on the customer’s abilities.
- What type of work programs will be provided for customers with disabilities? DFCS collaborates with employers, educators, trainers, and support service providers to ensure that TANF recipients have access to the resources needed to achieve the goal of self-sufficiency. ADA requirements apply to government agencies and to private entities that have entered contracts with DFCS to provide training and services. Therefore, entities contracted with DFCS are obligated to provide equal access to their services and programs for TANF customers with disabilities. These entities must provide Reasonable Modifications so that TANF customers with disabilities are able to receive the services and benefits for which they are otherwise eligible.