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

Form DSHS14-113 TR is a Washington State Department of Social and Health Services form also known as the "Your Cash And Food Assistance Rights And Responsibilities". The latest edition of the form was released in December 1, 2015 and is available for digital filing.

Download an up-to-date Form DSHS14-113 TR in PDF-format down below or look it up on the Washington State Department of Social and Health Services Forms website.

ADVERTISEMENT
ADVERTISEMENT

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

1350 times
Rate (4.8 / 5) 95 votes
ITEN CLIENT (MOKUREN FAMINI)
Omw Kewe Pwuung me Wisom
Ren Omw Aninisin Moni me Mwongo
AN EWE CLIENT NAMPAN ID
Your Cash and Food Assistance Rights and
Responsibilities
Wisom (Met Kopwe Fori)
Kopwe awora met mei auchea pwe aipwe tongeni appruf’ini omw fich ne nounou aninis.
Kopwe awora taropwen affat, ika mei namwot. Ika ka osukosuk, ina aipwe tongeni anisuk ne kutta porausom.
Ekoch meinapen federal me state repwe cheki me katonochu porausom. Angangen chekin porausom epwe for seni
ekoch chon angangen ewe depatmen me ewe ofesen choosa.
Ekoch poraus mei awora ngeni ewe Department of Social and Health Services a tongeni attaieno omw fich ne
angei ika nounou insurans weiweita ika health care, fan ewe Health Care Authority me ewe Health Benefit
Exchange.
Kopwe repotei akasiwinin nonomwum (omw address, niwinum, ika pwan ekoch) usun mei affat non annuk WAC
388-418-0005. Mei annuk kopwe repotei esap mang seni ewe Engon ran non ewe next maram.
Kopwe angang fengen me aninis fengen me ewe Division of Child Support (DCS) ika ka angei aninis seni
TANF (grant). Mei auchea kopwe anisi DCS an epwe fori, siwini, ika mina omw child support faniten noumw kewe
semirit (weiweita ika ion ke kan tutumwunu), me/ika fori ew tesen/chekin paternity (ika mei namwot). Mei auchea
kopwe fokkun fori chok met DCS e erenuk kopwe fori, me nukun chok ew popun mi öch, me ika ke fen nuokus
omw kopwe fori faniten omw nuokusiti semen ekkena semirit an epwe efeiengawok ika efeiengawa ekkewe semirit.
Kopwe apply ika tungor ren aninis me achocho ne kukut omw angang non atun omw fansoun nounoun aninisin
moni.
Kopwe fori omw kewe repot me refiu.
Kopwe fiti annukun angang ren aninisin moni me mwongo.
Kopwe asine ngeni kem ika pwe ka mwochen emon epwe nounou omw kewe aninis fanitom.
Kopwe fori ekkewe refiuwin Quality Control.
Kopwe nounou pwisin omw aninisin mwongo ne kamo mwongo tori noun chon non omw famini.
Kopwe nounou pwisin omw aninisin moni faniten omw famini chok.
Kopwe asine ngeni kem porausen noun ekkewe ekkoch soson re tungoren aninis (weiweita ika nour
nampan Social Security) (SSN) ika pwungun ar immigration status.
Ika mwo kose mochen ngeni kem nampan
noun ekkewe ekkoch soson rese amasow ngeni Basic Food, nge aupwe chok checki an meinisin chon nom non
ewe imw moni tonong pwe aipwe apwunguweno ami fich ne nounou aninis.
Omw Pwuung (Met Aipwe Fori)
Aipwe nengeni fichi omw application, pachanong itomw, omw address, me omw signature ika an omw chon
mwumwuta signature.
Aipwe anisuk ne amasowa noumw kewe taropwen DSHS.
Aipwe mina weiweita ika awora ngonuk omw aninisin mwongo non 7 ran ika omw famini mei osupwang me ika en
mei tufich ne angei “expedited service” ika aninisin atapwanapwan.
Aipwe ngonuk ew resiit ika kekan tungorem.
Aipwe toruk ewe mwuchunon finata me non taropwe esap mang seni 30 ran.
Ika kose mwochen kapas fengen me emon “Fraud Early Detection (FRED) investigator” (weiweita ika emon
chon choosa) seni ewe Ofesin Fraud and Accountability, ka tongeni erenii pwe “apw”. Ewe chon choosa esap
tongeni tonong non imwom ika pwe kose chok mwochen mwut ngenii. Ka tongeni tungoren an epwene niwin
sefanito inet chok epwe tawe ngonuk. Iwe, ewe chon choosa esap tongeni aosukosukok ika attapa ekkewe ekkoch
aninis en mei nomw won.
Ka tongeni tungor ren ew arongarong ika kose chok tipeew ngeni och fofor ika finata. Ka pwan tongeni tungoren
emon superfaisor ika administrator an epwe refiuwini porausom, iwe resap pwan tongeni attapa ekkewe ekkoch
aninis en mei nomw won ika angei senuk omw kewe pwuung.
Aipwe asine ngonuk porausen ewe “koukun 60-maram”, wewen, an emon me emon fansoun ne nounou
Temporary Assistance for Needy Families (TANF) esap tongeni nakatam seni 60 maram. Nge ei koukun ese
pwung ren omw Basic Food ika aninisin childcare.
Met Kopwe Sinei faniten Noum We EBT Card
Tanon Annukun Omw Pekin Aninis:
Nupwen kopwe nounou noum we EBT card ren mwongo ika moni, ekkewe
risit repwe affata ngeni DHS met ke nounou ngeni.
Ewe depatmen epwe nenengeni omw kewe risit, iwe epwe sinei
ika ka amömöno omw kewe food stamp ika benefit.  
Siwinin noum EBT card:
Ika pwe e poutuno noum we card iwe kopwe moni niwinin ach sipwe föri echö siwinin.
Pi kopwe tumwunu fichi noum we EBT card pwan omw na nampan PIN (personal identification number). 
“High Balance” EBT Card: Ika kose chok aia noum we card non chomong maram, ina omw we balance epwene
fen watteno. Iwe aipwe makkei ngonuk ika kokkoruk pwe aipwe tongeni refiuwini omw we account.
DSHS 14-113 TR (REV. 12/2015) Trukese
YOUR CASH AND FOOD RIGHTS AND RESPONSIBILITIES PAGE 1 NON 2
ITEN CLIENT (MOKUREN FAMINI)
Omw Kewe Pwuung me Wisom
Ren Omw Aninisin Moni me Mwongo
AN EWE CLIENT NAMPAN ID
Your Cash and Food Assistance Rights and
Responsibilities
Wisom (Met Kopwe Fori)
Kopwe awora met mei auchea pwe aipwe tongeni appruf’ini omw fich ne nounou aninis.
Kopwe awora taropwen affat, ika mei namwot. Ika ka osukosuk, ina aipwe tongeni anisuk ne kutta porausom.
Ekoch meinapen federal me state repwe cheki me katonochu porausom. Angangen chekin porausom epwe for seni
ekoch chon angangen ewe depatmen me ewe ofesen choosa.
Ekoch poraus mei awora ngeni ewe Department of Social and Health Services a tongeni attaieno omw fich ne
angei ika nounou insurans weiweita ika health care, fan ewe Health Care Authority me ewe Health Benefit
Exchange.
Kopwe repotei akasiwinin nonomwum (omw address, niwinum, ika pwan ekoch) usun mei affat non annuk WAC
388-418-0005. Mei annuk kopwe repotei esap mang seni ewe Engon ran non ewe next maram.
Kopwe angang fengen me aninis fengen me ewe Division of Child Support (DCS) ika ka angei aninis seni
TANF (grant). Mei auchea kopwe anisi DCS an epwe fori, siwini, ika mina omw child support faniten noumw kewe
semirit (weiweita ika ion ke kan tutumwunu), me/ika fori ew tesen/chekin paternity (ika mei namwot). Mei auchea
kopwe fokkun fori chok met DCS e erenuk kopwe fori, me nukun chok ew popun mi öch, me ika ke fen nuokus
omw kopwe fori faniten omw nuokusiti semen ekkena semirit an epwe efeiengawok ika efeiengawa ekkewe semirit.
Kopwe apply ika tungor ren aninis me achocho ne kukut omw angang non atun omw fansoun nounoun aninisin
moni.
Kopwe fori omw kewe repot me refiu.
Kopwe fiti annukun angang ren aninisin moni me mwongo.
Kopwe asine ngeni kem ika pwe ka mwochen emon epwe nounou omw kewe aninis fanitom.
Kopwe fori ekkewe refiuwin Quality Control.
Kopwe nounou pwisin omw aninisin mwongo ne kamo mwongo tori noun chon non omw famini.
Kopwe nounou pwisin omw aninisin moni faniten omw famini chok.
Kopwe asine ngeni kem porausen noun ekkewe ekkoch soson re tungoren aninis (weiweita ika nour
nampan Social Security) (SSN) ika pwungun ar immigration status.
Ika mwo kose mochen ngeni kem nampan
noun ekkewe ekkoch soson rese amasow ngeni Basic Food, nge aupwe chok checki an meinisin chon nom non
ewe imw moni tonong pwe aipwe apwunguweno ami fich ne nounou aninis.
Omw Pwuung (Met Aipwe Fori)
Aipwe nengeni fichi omw application, pachanong itomw, omw address, me omw signature ika an omw chon
mwumwuta signature.
Aipwe anisuk ne amasowa noumw kewe taropwen DSHS.
Aipwe mina weiweita ika awora ngonuk omw aninisin mwongo non 7 ran ika omw famini mei osupwang me ika en
mei tufich ne angei “expedited service” ika aninisin atapwanapwan.
Aipwe ngonuk ew resiit ika kekan tungorem.
Aipwe toruk ewe mwuchunon finata me non taropwe esap mang seni 30 ran.
Ika kose mwochen kapas fengen me emon “Fraud Early Detection (FRED) investigator” (weiweita ika emon
chon choosa) seni ewe Ofesin Fraud and Accountability, ka tongeni erenii pwe “apw”. Ewe chon choosa esap
tongeni tonong non imwom ika pwe kose chok mwochen mwut ngenii. Ka tongeni tungoren an epwene niwin
sefanito inet chok epwe tawe ngonuk. Iwe, ewe chon choosa esap tongeni aosukosukok ika attapa ekkewe ekkoch
aninis en mei nomw won.
Ka tongeni tungor ren ew arongarong ika kose chok tipeew ngeni och fofor ika finata. Ka pwan tongeni tungoren
emon superfaisor ika administrator an epwe refiuwini porausom, iwe resap pwan tongeni attapa ekkewe ekkoch
aninis en mei nomw won ika angei senuk omw kewe pwuung.
Aipwe asine ngonuk porausen ewe “koukun 60-maram”, wewen, an emon me emon fansoun ne nounou
Temporary Assistance for Needy Families (TANF) esap tongeni nakatam seni 60 maram. Nge ei koukun ese
pwung ren omw Basic Food ika aninisin childcare.
Met Kopwe Sinei faniten Noum We EBT Card
Tanon Annukun Omw Pekin Aninis:
Nupwen kopwe nounou noum we EBT card ren mwongo ika moni, ekkewe
risit repwe affata ngeni DHS met ke nounou ngeni.
Ewe depatmen epwe nenengeni omw kewe risit, iwe epwe sinei
ika ka amömöno omw kewe food stamp ika benefit.  
Siwinin noum EBT card:
Ika pwe e poutuno noum we card iwe kopwe moni niwinin ach sipwe föri echö siwinin.
Pi kopwe tumwunu fichi noum we EBT card pwan omw na nampan PIN (personal identification number). 
“High Balance” EBT Card: Ika kose chok aia noum we card non chomong maram, ina omw we balance epwene
fen watteno. Iwe aipwe makkei ngonuk ika kokkoruk pwe aipwe tongeni refiuwini omw we account.
DSHS 14-113 TR (REV. 12/2015) Trukese
YOUR CASH AND FOOD RIGHTS AND RESPONSIBILITIES PAGE 1 NON 2
Met Kopwe Sinei (Basic Food)
 Aipwe angei me aia fengeni porausen ekkewe chon tungoren Basic Food me pwan ekoch agency pwe sipwe cheki
pwungun ar tichikin poraus. Ika ka mwakken won noum kewe taropwe, ka tongeni kouno seni Basic Food. Mei wor
tipis ika ka attaieno ekkewe onnukun Basic Food. Ka tongeni kouno seni ei prokram me pakking, me pwan tongeni
kanopus ika pwe ke attai onnukun Basic Food. 
 Ika ka amömö, satuni ne amömö, siwini ika fangano omw kewe aninis ren moni (cash), safei mei afeiengaw
(drugs), pisekin fiu, ika pwan ekoch metoch, ina kopwe attai omw fich ne angei aninisin mwongo non ew ier, feita.
Omw pakking/penalty epwe chiwen soposopono, ina mwo ika ka towu seni Washington ika kosap.  
 Ika Basic Food e era pwe kopwe angang, nge kose chok fori met rekan erenuk kopwe fori, ka tongeni kouno seni
ewe prokram non ew (1) maram me tori omw kopwe awesi omw we angang; iwe epwe non unungat (3) maram ren
ewe orruan tanon onnuk; me epwe non wonu (6) maram ren ewe unungatin tanon onnuk, ika pwan ekkoch. 
 Ka tongeni kouno seni Basic Food ika ke attai ekkei onnukun Basic Food, usun met mei affat non ewe tettenin
pakkingen Basic Food.
 Repotenong omw moni touu (met moni ke nounou ne kamo me iteiten maram) ika ka mwochen ewe
depatmen epwe
onomu ekei niwin non met ke angang seni
omw Basic Food. Ika kose repotenong ekewe
metoch (asan), aipwe sinei nge kose mwochen am aipwe aia porausom ne finata ika en mei tufich ne angei pwan
ekkoch aninisin Basic Food.
Met Kopwe Sinei (Moni ika Cash)
 Ika ka angei aninis seni ewe prokramen Temporary Assistance for Needy Families (TANF) iwe en mei mutauu
omw kewe pwuung ngeni ewe Division of Child Support. Wewen nge ika ka angei child support nge kose fen
repotenong met kekan angei, iwe DCS e tongeni eimwunauu ika emwochu met kekan fen resiif seniir. Mei auchea
kopwe mwitir repotei ngeni DCS ika ka resiif monien child support ika pwan ekoch pekin aninis non fansoun
omw nonom won TANF.
 Ika kose chiwen resiif TANF, mei chiwen namwot omw kopwe repotei ngeni DCS ika a wor akesiwinin nonomwum,
weiweita ika noum we semirit ekan mwokut ika siwini an address ika pwan ekoch.
 Ika ka resiif TANF, ka tongeni tungoren pwan ekoch moni non fansoun atapwanapwan ren “temporary
emergency housing”.  
Usun a affat non annukun “Federal civil rights” me fan annukun ewe U.S. Department of Agriculture (USDA) civil rights,
ewe USDA, pwan an kewe Agency, ofes, chon angang, me institution re awora aninis seni ekoch prokramen muun
USDA esapw wor nefinifin ika angawa aramas non ach ekkei prokram ika fofor anongonong won ir chon ian, enuwen
unucher, meeni fonuer, ar namanam, ir mwan ika fefin, met ar nukuw are choni (pachanong ika re sani mwan are fefin),
ir tongei mwan are fefin, terir ika wanengawen ren inisir, ierir, ir mei pwupwunu are resapw, a wor ika ese wor nour
famini / semirit, ir mei angei moni seni och prokramen aninis ika prokramen public assistance, met rekan nuku, are ika ir
mei fen piin atouranong och otutur faniten och foforun civil rights, fan ekewe foforun ika prokramen USDA (nge esap
unusen prokramen muun). Pi kopwe katon met ekkewe annuk meinisin faniten ew me ew prokram.
Ekewe mei wor ar terin inisir / mokurer are ika ir mei mochen angei pwan ekoch sokkun poraus (weiweita ika ekewe
rese tongeni rong ika kapas nge re aia Braille, mak mei wate, audiotape, American Sign Language, ika pwan ekoch)
repwe kori ew Agency ika ewe USDA TARGET Center ren (202) 720-2600 (kapas ika TTY) ika kori ewe USDA non
ewe Federal Relay Service ren (800) 877-8339. Ka pwan tongeni tungor ren omw kopwe angei ekoch auchean taropwe
ika eman chon chiaku non foosun fonuom.
Ren omw kopwe faenini ew otutur, kopwe amasowa ewe USDA Program Discrimination Complaint Form
AD-3027, won kamputer ren
http://www.ascr.usda.gov/complaint_filing_cust.html
are ka tongeni chuto ngeni ew ofesin
USDA office or mak ngeni ewe USDA o tinano met re nit senuk. Ren omw kopwe tungor ren eche kapin ewe taropwen
otutur, kori (866) 632-9992. Kopwe faenini noum taropwen otutur ngeni USDA ren:
1. Posto: 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; ika
3. Email:
program.intake@usda.gov
USDA ew prokram mei pwung me wenechar, iwe esapw nefinifin aramas non an aworan moni me aninis.
Ika uwa saini ei taropwe me fan, a pwarata pwe ngang mei annean fichi unusen ekkei pwuungun/wisen DSHS iwe ra
pwan weweoch ngeni ei. Uwa pwan sinei nge ika use mwochen saini ei taropwe, resap tongeni attapa ekkewe ekkoch
aninis ngang mei nomw won ika angei seniei ai kewe pwuung, nge upwe chok chiwen fiti annukun ei pekin aninis pwe
esap wor ai pakking ika tipis.
AN CHON TUNGOR SIGNATURE
PWININ MARAM
AN CHON TUNGOR SIGNATURE
PWININ MARAM
AN CHON ANGANGEN DSHS “ACES” NAMPAN ID:
Ese chok mwochen saini ei taropwe.
DSHS 14-113 TR (REV. 12/2015) Trukese
YOUR CASH AND FOOD RIGHTS AND RESPONSIBILITIES PAGE 2 NON 2
Page of 2