DSHS Form 14-113 "Your Cash and Food Assistance Rights and Responsibilities" - Washington (Marshallese)

Form DSHS14-113 MS or the "Your Cash And Food Assistance Rights And Responsibilities" is a form issued by the Washington State Department of Social and Health Services.

Download a PDF version of the Form DSHS14-113 MS down below or find it on the Washington State Department of Social and Health Services Forms website.

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Download DSHS Form 14-113 "Your Cash and Food Assistance Rights and Responsibilities" - Washington (Marshallese)

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CLIENT NAME (HEAD OF HOUSEHOLD)
Jiṃwe ko im Eddo ko Aṃ Ikijien Jibañ
in Jāān im Ṃōñā
CLIENT ID NUMBER
Your Cash and Food Assistance Rights and Responsibilities
Eddo ko aṃ (Kwoj aikuuj in)
Letok meḷ ele ko kōm ej aikuj kake ñan ad komman jemlok elaññe kwomaroñ bōk jibañ ko ak jab.
Letok kein kaṃool ñe kōm ej aikuji. Bōlen kōm ej maroñ būkōti kōn kwe. Kōjjeḷ ā ko kwoj letok department eo ri jerbal in federal im state remaroñ
lale bwe reṃool. Ri jerbal in department ro im ri lale kọọt (fraud investigators) remaroñ kepaake eok ñan lale bwe kwaar jab riab.
Meḷ ele ko kwoj leḷọ k ñan Department of Social and Health Services remaroñ jelet am maroñ bōk insurance in tōkto kōn Health Care Authority
im Health Benefit Exchange eo.
Kwon ba tok ñe ewor jabdewōt ej oktak (e.g. atōrej eo aṃ, wōnān jāān eo aṃ, im men rot kein) ekkar ñan WAC 388-418-0005. Kwon kōnono
kake ṃōkta jān 10 raan in aellōñ in laḷ .
Kwon jerbal ippan Division of Child Support (DCS) eo elaññe kwoj bōk jāān in TANF. Kwoj aikuj in jibañ DCS kile, kajiṃwe, ak kōṃṃan bwe
armej en kōllā jibañ (child support) ñan ajiri ro kwoj kōjparōk kake, im kile wōn eo jemāer (ñe rej aikuji). Kwomaroñ borokuk in jibañ DCS ñe
kwomaroñ kwaḷọ k bwe ewōr unin ko reṃṃan in lōṃṇ ak bwe elaññe kwoj jibañ DCS eo emaroñ kōṃṃane aṃ kauwōtata in jorāān jān armej eo ejjab
jokwe im kōjparok ajiri ro ñan kwe, ajiri ro nejūṃ, ak ajiri ro kwoj kōjparok kake.
Kwon aplai im kwon lukkun kajjioñ in bōk jāān jān jikin ko jet ñe kwoj kajjitōk kōn ak bōk jibañ in jāān.
Kwon kadede aolep ripoot (pepa in kwaḷọ k) ko im ko nan etali.
Kwon lọọre aikuuj ko in jerbal ñan aṃ maroñ bōk jibañ in jāān im ṃōñā.
Kwon ba tok ñe kwokōṇ aan bwe bar juon armej eo en kajerbali jibañ in ṃōñā ko aṃ im bok jikūṃ.
Kwon jibañ ilo etale ko in Quality Control (ak kweilọk in lale bwe aolep men ko reṃṃan).
Kwon kajerbali jibañ in ṃōñā ñan wiia ṃōñā ko kijōn armej ro ilo ṃweo iṃōṃ wōt.
Kwon kajerbali jāān in jibañ ñan jibañ armej ro ilo ṃweo iṃōṃ wōt.
Kwoj aikuj in letok Nōmba in Social Security (SSN) ak kadkad in immigration an armej ro rej aplaiki kōn jibañ wōt. Elaññe kwoj kālōt in jab letok
SSN ak kadkad in immigration an armej ro rej jokwe ilo ṃweo iṃōṃ im rejjab aplaiki, DCS ej bar aikuj in kaṃool an aolep armej ilo ṃweo jāān im
ṃweiuk ko, ñan kile bwe kwomaroñ bōk jibañ ak jab.
Eddo ko Aṃ (Jej aikuuj in)
Bōk juon pepa in aplai eo ej kwalok etaṃ, atōrej, im jain eo aṃ ak jain eo an armej eo ej bōk jikūṃ.
Jibañ eok bwe kwon kadede pepa in DSHS ko.
Riiti im kadedelok pepa in aplikaition eo aṃ kōn jibañ in ṃōñā ṃōkta jān 7 raan ñe ewōr aṃ melim in jerbal in jibañ eo emōkaj.
Lewōj juon receipt ñe kwoj kajjitōk kake ilo iien eo kwoj letok pepa ko.
Lewōj juon enaan in kōjeḷ ā eo ej ba ta eo kōm ar kālōt, emmakijkij, ṃōkta jān 30 raan.
Kwomaroñ ṃakoko in kōnono ippān juon ri etale jorren (investigator in Fraud Early Detection (FRED ak doulul in kile kọọt) jān Office of Fraud
and Accountability. Kwojjab aikuuj kōtḷọ k bwe en delōñ ilo ṃweo iṃōṃ ñe kwojjab kōṇ aan. Kwomaroñ kajjitōk ippān ri investigator eo bwe en
rọọlwōj bar juon raan. Men in eban jelet aṃ maroñ bōk jibañ.
Kwomaroñ kajjitōk bwe ren lewōj juon kweiḷọ k ippān opiij eo eḷ ap ñe kwoj jab erre ilo juon kālōt eo department eo ej kōṃṃane ilo case eo
aṃ. Kwomaroñ kajjitōk ippān juon ri lale ak juon ri administrator bwe en bar riiti kālōt eo ak makūkūt eo im eban jelet jiṃwe ko aṃ in bōk juon
kweilọk eḷ ap.
Kōm ej aikuuj in ba wōj bwe ewōr juon kakkien in jeṃḷ ọk in 60 aellōñ iuṃwin program in Temporary Assistance for Needy Families (TANF).
Kakkien in jeṃḷ ọk in ejjab waḷọ k ilo aṃ maroñ bōk jāān in ṃōñā eo etan Basic Food ak jāān in kōllā armej ro bwe ren kaajiriri ajiri ro nejūṃ.
Men ko Kwon Jeḷ ā kake EBT Card eo Aṃ
Eṃo Kajerbale Jibañ ko ilo Wāween ko Renana: Jibañ in ṃōñā im jāān ko rej lewōj ilo EBT card enaaj letok ñan DSHS juon ḷọọ k in men ko
kwaar kajerbali jibañ kaṇ ak men ko kwaar wiia. Department eo enaaj kajerbali ḷọọ k in men ko kwaar wiia ñan kile ñe kwoj kajerbali jāān eo ilo
wāween ko renana ak wiiakake ṃōñā ko bwe armej en lewōj jāān ak ṃweiuk ko jet (etan ‘trafficking’ ilo Kajin Belle).
Bōk bar juon EBT card: Kwomaroñ aikuj kōllā bwe ren lewōj bar juon EBT card ne ejako card eo am. Kwon kōjparrōk EBT card im nōmba eo aṃ
(PIN) bwe armej ro jet ren jab bōki.
EBT Card ko ebwol Jāān ie: Ñe kwojjab kajerbali jibañ ko aṃ ilo bwijin aellōñ ko ak ebwol jāān ilo akauṇ eo aṃ ālkin bwijin aellōñ, kōm maroñ
kepaake eok ñan bar lale kadkad eo aṃ ak lale elaññe kwoj aikuj jibañ ak jab.
Men ko Kwoj aikuuj Jeḷ ā kake ṃōñā (Basic Food)
Jiṃwe ko im Eddo ko Aṃ in Jibañ in Jāān im Ṃōñā Peij 1 / 2
DSHS 14-113 MS (REV. 12/2015) MARSHALLESE
CLIENT NAME (HEAD OF HOUSEHOLD)
Jiṃwe ko im Eddo ko Aṃ Ikijien Jibañ
in Jāān im Ṃōñā
CLIENT ID NUMBER
Your Cash and Food Assistance Rights and Responsibilities
Eddo ko aṃ (Kwoj aikuuj in)
Letok meḷ ele ko kōm ej aikuj kake ñan ad komman jemlok elaññe kwomaroñ bōk jibañ ko ak jab.
Letok kein kaṃool ñe kōm ej aikuji. Bōlen kōm ej maroñ būkōti kōn kwe. Kōjjeḷ ā ko kwoj letok department eo ri jerbal in federal im state remaroñ
lale bwe reṃool. Ri jerbal in department ro im ri lale kọọt (fraud investigators) remaroñ kepaake eok ñan lale bwe kwaar jab riab.
Meḷ ele ko kwoj leḷọ k ñan Department of Social and Health Services remaroñ jelet am maroñ bōk insurance in tōkto kōn Health Care Authority
im Health Benefit Exchange eo.
Kwon ba tok ñe ewor jabdewōt ej oktak (e.g. atōrej eo aṃ, wōnān jāān eo aṃ, im men rot kein) ekkar ñan WAC 388-418-0005. Kwon kōnono
kake ṃōkta jān 10 raan in aellōñ in laḷ .
Kwon jerbal ippan Division of Child Support (DCS) eo elaññe kwoj bōk jāān in TANF. Kwoj aikuj in jibañ DCS kile, kajiṃwe, ak kōṃṃan bwe
armej en kōllā jibañ (child support) ñan ajiri ro kwoj kōjparōk kake, im kile wōn eo jemāer (ñe rej aikuji). Kwomaroñ borokuk in jibañ DCS ñe
kwomaroñ kwaḷọ k bwe ewōr unin ko reṃṃan in lōṃṇ ak bwe elaññe kwoj jibañ DCS eo emaroñ kōṃṃane aṃ kauwōtata in jorāān jān armej eo ejjab
jokwe im kōjparok ajiri ro ñan kwe, ajiri ro nejūṃ, ak ajiri ro kwoj kōjparok kake.
Kwon aplai im kwon lukkun kajjioñ in bōk jāān jān jikin ko jet ñe kwoj kajjitōk kōn ak bōk jibañ in jāān.
Kwon kadede aolep ripoot (pepa in kwaḷọ k) ko im ko nan etali.
Kwon lọọre aikuuj ko in jerbal ñan aṃ maroñ bōk jibañ in jāān im ṃōñā.
Kwon ba tok ñe kwokōṇ aan bwe bar juon armej eo en kajerbali jibañ in ṃōñā ko aṃ im bok jikūṃ.
Kwon jibañ ilo etale ko in Quality Control (ak kweilọk in lale bwe aolep men ko reṃṃan).
Kwon kajerbali jibañ in ṃōñā ñan wiia ṃōñā ko kijōn armej ro ilo ṃweo iṃōṃ wōt.
Kwon kajerbali jāān in jibañ ñan jibañ armej ro ilo ṃweo iṃōṃ wōt.
Kwoj aikuj in letok Nōmba in Social Security (SSN) ak kadkad in immigration an armej ro rej aplaiki kōn jibañ wōt. Elaññe kwoj kālōt in jab letok
SSN ak kadkad in immigration an armej ro rej jokwe ilo ṃweo iṃōṃ im rejjab aplaiki, DCS ej bar aikuj in kaṃool an aolep armej ilo ṃweo jāān im
ṃweiuk ko, ñan kile bwe kwomaroñ bōk jibañ ak jab.
Eddo ko Aṃ (Jej aikuuj in)
Bōk juon pepa in aplai eo ej kwalok etaṃ, atōrej, im jain eo aṃ ak jain eo an armej eo ej bōk jikūṃ.
Jibañ eok bwe kwon kadede pepa in DSHS ko.
Riiti im kadedelok pepa in aplikaition eo aṃ kōn jibañ in ṃōñā ṃōkta jān 7 raan ñe ewōr aṃ melim in jerbal in jibañ eo emōkaj.
Lewōj juon receipt ñe kwoj kajjitōk kake ilo iien eo kwoj letok pepa ko.
Lewōj juon enaan in kōjeḷ ā eo ej ba ta eo kōm ar kālōt, emmakijkij, ṃōkta jān 30 raan.
Kwomaroñ ṃakoko in kōnono ippān juon ri etale jorren (investigator in Fraud Early Detection (FRED ak doulul in kile kọọt) jān Office of Fraud
and Accountability. Kwojjab aikuuj kōtḷọ k bwe en delōñ ilo ṃweo iṃōṃ ñe kwojjab kōṇ aan. Kwomaroñ kajjitōk ippān ri investigator eo bwe en
rọọlwōj bar juon raan. Men in eban jelet aṃ maroñ bōk jibañ.
Kwomaroñ kajjitōk bwe ren lewōj juon kweiḷọ k ippān opiij eo eḷ ap ñe kwoj jab erre ilo juon kālōt eo department eo ej kōṃṃane ilo case eo
aṃ. Kwomaroñ kajjitōk ippān juon ri lale ak juon ri administrator bwe en bar riiti kālōt eo ak makūkūt eo im eban jelet jiṃwe ko aṃ in bōk juon
kweilọk eḷ ap.
Kōm ej aikuuj in ba wōj bwe ewōr juon kakkien in jeṃḷ ọk in 60 aellōñ iuṃwin program in Temporary Assistance for Needy Families (TANF).
Kakkien in jeṃḷ ọk in ejjab waḷọ k ilo aṃ maroñ bōk jāān in ṃōñā eo etan Basic Food ak jāān in kōllā armej ro bwe ren kaajiriri ajiri ro nejūṃ.
Men ko Kwon Jeḷ ā kake EBT Card eo Aṃ
Eṃo Kajerbale Jibañ ko ilo Wāween ko Renana: Jibañ in ṃōñā im jāān ko rej lewōj ilo EBT card enaaj letok ñan DSHS juon ḷọọ k in men ko
kwaar kajerbali jibañ kaṇ ak men ko kwaar wiia. Department eo enaaj kajerbali ḷọọ k in men ko kwaar wiia ñan kile ñe kwoj kajerbali jāān eo ilo
wāween ko renana ak wiiakake ṃōñā ko bwe armej en lewōj jāān ak ṃweiuk ko jet (etan ‘trafficking’ ilo Kajin Belle).
Bōk bar juon EBT card: Kwomaroñ aikuj kōllā bwe ren lewōj bar juon EBT card ne ejako card eo am. Kwon kōjparrōk EBT card im nōmba eo aṃ
(PIN) bwe armej ro jet ren jab bōki.
EBT Card ko ebwol Jāān ie: Ñe kwojjab kajerbali jibañ ko aṃ ilo bwijin aellōñ ko ak ebwol jāān ilo akauṇ eo aṃ ālkin bwijin aellōñ, kōm maroñ
kepaake eok ñan bar lale kadkad eo aṃ ak lale elaññe kwoj aikuj jibañ ak jab.
Men ko Kwoj aikuuj Jeḷ ā kake ṃōñā (Basic Food)
Jiṃwe ko im Eddo ko Aṃ in Jibañ in Jāān im Ṃōñā Peij 1 / 2
DSHS 14-113 MS (REV. 12/2015) MARSHALLESE
Kōmij jilikinḷọ k meḷ ele ko an armej ro rej aplai kon jibañ in ṃõñã Basic Food ñan doulul ko jet relaplap (Federal) bwe ren lale bwe kōjjeḷ ā ko
rejiṃwe. Elaññe jabdewōt kain kōjjeḷ ā eo ejjab ṃool, armej ro raar aplaiki reban bōk jibañ in ṃōñā Basic Food. Eḷ aññe armej eo ej letok melele ko
rej jeḷ ā rejjab ṃool, remaroñ kourt. Kaje ko ñan armej ro rejjab bokake kien Basic Food eo ej bwe reban maroñ bōk jibañ jān prokuraam, kobakkiin,
ak kalibuuj.
Elaññe kwoj wiiakake, kajjiōñ in wiiakake, jānij ak leḷọ k jibañ in ṃōñā eo aṃ ñan bar juon bwe en lewōj jabdewōt kain ṃweiuk ko āinwōt jāān,
uno ko rekajuur (drugs), kein tarinae ko (weapon), ak jabdewōt kain men eo ejjab ṃōñā ak jān juon ṃwōn wiia ejañin kamelim (trafficking),
kwomaroñ jemḷọ k melim eo aṃ in bōk jibañ in ṃōñā ilo juon iiō ak lōñḷọ k ak ñan indeeo ilo iien eo kein kajuon kwoj rupi kōkkien eo. Kwo maroñ
emakitḷọ k jān State of Washington ñan bar juon state im kwoban bōk melim in jibañ in ṃōñā ilo bar juon state.
Elaññe kwoj aikuuj in jerbal ak būkot jerbal ñan aṃ maroñ bōk jibañ in ṃōñā (Basic Food work), im kwojjab jerbal, kwomaroñ jemḷọ k aṃ
melim in bōk jibañ ilo juon aellōñ im ṃae kwoj kōṃṃane ekkar ñan aikuj ko in jerbal ilo bōd kein kajuon; jilu aellōñ ko ak mae kwoj kōṃṃane ekkar
ñan aikuj ko ilo bōd kein karuo; ak jijino aellōñ im mae kwoj bokake kien eo ilo bōd kein kajilu im jabdewōt iien ālikin.
Remaroñ kaje im jab lewōj melim in bōk jibañ in ṃōñā (Basic Food) kōn aṃ rubi kiien ko ilo program in Basic Food ekkar ñan ta ej ba ilo enaan
in kōkōl eo ej jeje kake ilo peij in.
Kwon bripoot tok kōn men ko kwoj wiia ñan ṃweo iṃōṃ ñe kwokōṇ aan bwe rej kōllā wōj ilo Basic Food. Elaññe kwoj jab ba tok kōn men ko
kwoj wiia rot in im kwoj jab letok kein kaṃool, kwoj ba bwe kwojjab kōṇ aan bwe kōmin kajerbali men kein ñan am kālōt ñe kwomaroñ bōk Basic
Food ak jab.
Men ko Kwon Jeḷ ā Kake (Jāān)
Ilo aṃ bōk Temporary Assistance for Needy Families (TANF) kwoj letok jiṃwe ko in ajiri ro nejūṃ im leo ak ḷ io ippaṃ ñan Division of Child
Support eo. Men in ej meḷ eḷ e bwe DCS emaroñ bōk jāān in jibañ ko rej muri ippaṃ, ñan kōllā jibañ eo state eo ej lewōj. Kwon kajju ba tok ñan
DCS elaññe kwoj bōk jabdewōt kain kōllā in jibañ ñan ajiri ro ak jibañ ko jet ñan ajiri ro ilo iien eo kwaar pād ilo TANF.
Elaññe ejemḷọ k aṃ TANF kwoj aikuuj ba ñan DCS kōn jabdewōt men ko raar jānij kōn jibañ ñan ajiri ro (child support), āinwōt ñe ajiri ro raar
mootḷọ k ak atōrej eo aṃ eaar jānij.
Ñe kwoj bōk TANF, kwomaroñ kajjitōk bwe ren lewōj jāān ñan aṃ kōllā kōn housing ilo jiddik wōt iien ilo iien idiñ.
Ekkar ñan kakien in jimwe in armej an kien ko rekilepkilep (Federal law) im kakien in jimwe in armej an U.S. Department of Agriculture (USDA) eo im ri-
jerbal ro im doulul ko rej bōk kunaer ak rej bōk eddo in program ko in USDA rejjab maroñ kalijekḷọ k armej kōn armej rot, kalar in kilin, ijo ej itok jān ie,
jar, emmaan ak kōrā, kadkad in emmaan ak kōrā (bareinwōt wāwein ṃakūtkūt in emmaan ak kōrā), ñe ekōṇ aan kiki ippān emmaan ak kōrā, men ko
rejorrāān ilo ānbwinnin, jete an iiō, ñe eppāllele ak jab, kadkad in baaṃle / jinen ak jemān, jete wōṇ āān ej bōk jān program in jipañ ñan jukjukinpād,
tomak in politic, ak āinwōt iden-oṇ e kōn ṃakūtkūt in jimwe in armej, ilo jabdewōt program ak ṃakūtkūt eo ej kōḷḷ
ā jān USDA (jab aolep base ko ej
aplaiki ñan aolep program ko). Deadline ñan uwaake ak kōṃṃane juon abṇ ōṇ ō ej oktak ekkar ñan program.
Armej ro ewōr jorrāān ilo ānbwinier im rej aikuj bar jet wāwein kōnono im bōk kein melele kin program (āinwōt joñak, Braille, leta ko rekilep, audiotape,
American Sign Language, im wāwein ko jet) ren kepaake Doulul eo ej bōk eddo ak TARGET Center in USDA ilo (202) 720-2600 (voice im TTY) ak
kepaake USDA ilo Federal Relay Service ilo (800) 877-8339. Bareinwōt, kein kōjeḷ ā in program emaroñ kōṃṃane ilo kajin ko ijellọkun Kajin Iñlij.
Ñan kōṃṃane juon abṇ ōṇ ō in kalijekḷọ k, kwōn kadede USDA Program Discrimination Complaint Form (Peba in Abṇ ōṇ ō in Kalijekḷọ k in Program in
USDA), AD-3027, eo ej pād ilo internet ilo http://www.ascr.usda.gov/complaint_filing_cust.html im ilo jabdewōt opij in USDA ak jeje juon leta ñan USDA
im jeje ilo leta aolep kein kōjeḷ ā ko ej kajjitōk kake ilo peba. Ñan kajjitōk bwe ren lewōj juon anōk in peba in abṇ ōṇ ō, kwōn kaḷọ k (866) 632-9992.
Leḷọ k peba ak leta eo ekadedeḷọ k ñan USDA.
1.
Mail: U.S. Department of Agriculture
Office of the Assistant Secretary for Civil Rights
1400 Independence Ave, SW
Washington, D.C. 20250-9410;
2.
Fax: (202) 690-7442; or
3.
Email:
program.intake@usda.gov
ḷọk, ri
ḷọk.
USDA ej juon ri-le
-kajerbal armej im ri-kamuri ejjab kalijek
Ilo aō jain, ij kamọoḷ bwe raar riiti im kameḷ eḷ e tok jiṃwe ko aō im eddo ko aō kōn bōk jibañ jān DSHS im program ko jet. Ij meḷ eḷ e bwe elaññe ijjab
jain pepa in ejjab jānij aō maroñ bōk jibañ ak ibar aikuj in makūtkūt ekkar ñan aikuj ko ilo program im imaroñ kaje ilo iien ko ij rubi kien ko ilo program.
JAIN EO ETAN RI APLAIKI
RAAN
JAIN EO ETAN RI BAR APLAIKI
RAAN
Jab kōṇ aan jain.
ID IN ACES AN RI JERBAL IN DSHS:
Jiṃwe ko im Eddo ko Aṃ in Jibañ in Jāān im Ṃōñā Peij 2 / 2
DSHS 14-113 MS (REV. 12/2015) MARSHALLESE
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