Conn. Agencies Regs. § 17-619-6 - Procedures

(a) Each mediation agency shall have and utilize a written intake procedure which shall include, but not be limited to:

(1) a procedure for making and accepting referrals; and

(2) a procedure for determining whether or not the family meets the program's admission criteria and is appropriate for the program.

(b) Each mediation agency shall, during the intake procedure, collect at least the following information on an application form from each family seeking admission to the program:

(1) name;

(2) home address;

(3) telephone number;

(4) date of birth;

(5) family status;

(6) income source(s);

(7) current family income (of all household members);

(8) amount of arrearage or delinquency;

(9) reason(s) for arrearage or delinquency;

(10) social security number;

(11) referral source;

(12) date of initial contact;

(13) date of interview;

(14) signature and title of intake worker; and

(15) applicant's signature.

Notes

Conn. Agencies Regs. § 17-619-6

Effective October 1, 1993