SFN 429, Memorandum of Agreement to Establish Protective Payment 400-19-165-70

(Revised 6/1/10 ML #3218)

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SFN 429, Memorandum of Agreement to Establish Protective Payments form is used if the protective payee method is needed as an alternative payment method.

 

Regulations require a protective or vendor payment whenever a TANF recipient (1) persistently mismanages their funds to the detriment of the children's best interests, or (2) refuses without "good cause" to comply with the terms of the TANF contract. This agreement briefly defines the conditions under which the protective payee agrees to serve and provides minimum identifying information about the household that is helpful to all parties concerned.

 

A copy of the completed and signed agreement shall be given to the recipient and the protective payee, and filed in the recipient's case record.

 

This form is available through the Department of Human Services and may also be obtained electronically via E-Forms. (42kb pdf)

 

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