FORM H2444
Instructions

REFUGEE CASH ASSISTANCE (RCA)
REQUEST FOR WORKING CAPITAL ADVANCE

02-2003

PURPOSE

To request a cash advance for the purpose of paying Refugee Cash Assistance (RCA) client payments due at the beginning of the following month.

PROCEDURE

When to Prepare

Use this form when you need to request a cash advance for client payments.

Number of Copies

Make one copy.

Transmittal

Fax or email Form H2444 to HHSC's Office of Immigration and Refugee Assistance (OIRA) by noon on the 20th day of the month before client payments are due.

Mail the original to OIRA within five days of your fax or email.

Form Retention

Keep a copy on file for three years and 90 days after the end of the contract period.

DETAILED INSTRUCTIONS

For Service Month and Year —  Indicate in the space provided the month and year that the funds will be paid to RCA participants.

Agency Information —  Complete all information requested about your agency.

Months 1-4 —  On the line indicating the appropriate family unit size, note in Column A (No. Enrolled) the number of family units enrolled in RCA that are in benefit months 1-4. Indicate in Column B (Cash Payments) the amount of benefits that will be paid out.

Months 5-8 —  On the line indicating the appropriate family unit size, note in Column C (No. Enrolled) the number of family units enrolled in RCA that are in benefit months 5-8. Indicate in Column D the amount of benefits that will be paid out.

Totals —  Total each of the four columns.

Requested Advance —  Add the two Cash Payment totals (total of columns B and D) and enter the total.

Authorization —  The agency's authorized certifying official must sign and date the form. Type or print the name and title of the certifying official and provide a telephone number with area code (and extension if appropriate) for the official.