AREA AGENCY VERIFICATION OF APPLICATION

 
  1. The Area Agency on Aging of ______________________ verifies the application of

___________________ (name of applicant) for:

_____Benefits Counselor not certified _____(check, if certification incomplete)

_____Benefits Counselor I _____ (check, if for re-certification)

_____Benefits Counselor II _____ (check, if for re-certification)

  1. The area agency further verifies that the applicant has successfully completed and has adequate documentation, on the following:

_____Certification pending

_____ 25 hours required training, topics covered

_____ 20 hours counseling, with oversight

_____ at least a minimum passing score on the self-assessment

For Benefits Counselors II:

_____ 5 additional hours administrative appeals training, topics covered

_____ served as advocate in at least one mock or real administrative appeals hearing

  1. The applicant is seeking re-certification and has completed:

_____ 12 additional hours of training on public/private benefits and related legal issues

  1. The applicant is (check one):

_____ an employee of the area agency

_____ a volunteer of the area agency or staff of a provider

 

The area agency further verifies that the applicant does not present a conflict of interest with the HICAP program.

 

_______________________________________________________ ____________
DIRECTOR, AREA AGENCY ON AGING  DATE

Benefits Counseling Certification Program Chapter Two--6/2000


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