Form 814

Georgia Department of Human Resources
SELECTION OF THE DESIGNATED ADULT

Case Name _______________________________

Case Number _____________________________

You are being asked to choose a person in your Food Stamp (FS) Assistance Unit to be the Head of the Assistance Unit for Employment and Training and Voluntary Quit purposes. This person will be called the Designated Adult. This person may or may not be the same person that applies for the Food Stamps, and may be different from the person selected as the Head of the Food Stamp Assistance Unit.
A choice of the Designated Adult is very important in determining how your Food Stamp case is penalized. If an Assistance Unit member is the Designated Adult and fails to cooperate with the Employment and Training program, or if he/she quits a job without good cause, the Food Stamp case is closed.
Failure to cooperate with the Employment and Training program causes penalties in your Food Stamp case. Either the person who fails to cooperate is removed from the Food Stamp case, or the Food Stamp case is closed for a minimum of one, three, or six months. The Food Stamp case is closed when the person who fails to cooperate is the Designated Adult.
The choice you make also determines whether or not your case is closed if an Assistance Unit member voluntarily quits his/her job. If the Designated Adult voluntarily quits a job, the Food Stamp case is closed for a minimum of one, three, or six months. If an Assistance Unit member quits a job, that Assistance Unit member is not eligible for a minimum of one, three, or six months.
If your Assistance Unit contains an Adult Parent of Children, this person may be chosen as the Designated Adult. This could protect your case from being closed if another Assistance Unit member is likely to quit a job or not cooperate with the Employment and Training program. An Assistance Unit may select the Primary Earner or an Adult Parent of Children.
All adult members of the Assistance Unit must agree to the selection. If no selection is made, or all adults cannot agree, the agency will make the selection for the Assistance Unit. The agency will select the Primary Earner (first) or the Head of the Food Stamp Assistance Unit (second).

The Assistance Unit may only make a selection at the time of application, review, or when there is a change in the Assistance Unit's composition. At this time, you should indicate to your caseworker that you would like to change your selection. A change in selection may NOT be made when a penalty is being faced, in order to avoid the penalty. You may only make a selection by completing this form. The opportunity to make a selection is only given to Assistance Units containing an Adult Parent of Children.

______________________________________ ____________________
Signature Date

______________________________________ ____________________
Signature of Person Applying Date

Form 814 (Rev. 1-97)