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PEAK Reference Guide

1. NEI coeso sso nos ooo ee ass sas cossocssessosssssssoncssossocesosseessossonssssssssessos 37 Defining Liquid Assets A ees oee ooe soe coe Eles sse seseesoseccesosssosssssssssccsosecoesoessessesssssso 37 Review of Liquid Assets e e oee ooe Eas eoe oee ooe so END essees ses sssocesossoossosssesssssseeccsoseocssoss 38 Completing Other Assets sses ees oee Mho soo noo oo Ena eee ooe one AD o nec ess sac vaccsscnsccssenseepeconscnssecssees 40 Defining OTN eRSSCTS W s o C T o ee son soosse soosoo sssssncesoessoossossonsssssessesasese 40 Review of ONEBAssets WA c C ccnsecnceccnstironcescoscosceecnscoscoscnecnscoscoscescrsosssessensens 42 Completing Job INCOMERRDD E eee see osese ODs sss essessoceccesocssessosssssssoncessossoossossonssssssssesssesssssossseso 43 Reviessafjob In CORR C n e Doso soe soosoo ooe soecoesoesoescesecoeeseessesecoeeseesecsecseccccccceeseese 45 COM ple tigi eeEFTO PR RTRING E a ee NEM econ neces cncaccsensasccnsenseesecconencensacnsasraserecnsccnsenspscees 46 BETICW of Otheihcome WE e er essee MMM rec csssescrssssssssscsessnssesceccsccsssesvescsccssuessccsccssecseesssees 47 COM ple TRB Housing Bills W N ees ees oeessessesssssssssesscsscesossocecossecssossosssessssasesoseosecossoossessesssesssos 48 Revi taof Housing BNED ERs eeesoesserssssseesessocecceseessossesssssssssessossocesossoonssssssrsesssesessoseoosso 52 Comp
2. Review Your Answers Medical Costs Please check the box for anyone who has monthly medical costs By medical costs we mean doctor bills medicine insurance premiums transportation to medical services home care r Lilac Wysteria Forsythia No one Colorado gov Colorado Dept of Human Services Colorado Dept of Health Care Policy and Financing Accessibility CO PEAK CBO Application User Manual Draft 5 12 2010 Page 54 Completing the Final Questions Before the client can initiate the application there are a few more health insurance and education questions that must to be completed an Services Colorado Dept of Health Care Policy and Financing Accessib E about benefits that the people in your home may get ox for anyone who gets or is entitled to get Medicare Part A or Part B th insurance program for elderly 65 or older blind or disabled people Part A is also known pis also known as Medical coverage Keep in mind that Medicare is not the same as Medicaid Bve a Red White and Blue card Sis z pots i e box for anyone who has health care coverage now or has had health care coverage in the last O LO RA B O f y PRS ai cay gt ie nd ge we mean any insurance policy that pays for a doctor s services in an in patient or outpatient e P K Y ed to only to accidents disability vision care long term care or dental services you should not
3. Start More About Parents It looks like the father of Lilac is not living in your home Please type information about the father of Lilac in the boxes below If you do not know the name of the father of Lilac leave it blank First Name Middle Initial Last Name Cedar Bush Liquid Assets Date of Birth Other Assets 2 Social Security Number Job Income Address Street Other Income PO Box or Street Name gt Housing Bilis miko City State Zip Code Colorado ve ii Other Bilis Phone Number Place of Employment Finish Back Save amp Exit Next Colorado PEAK will ask if the parent listed is the same for all children in the household Since Cedar Bush is the father of all of Rose s children there is no need to re enter this information for each child in this case If that wasn t the case then the applicant will need to enter in each of the children s father s information into PEAK CO PEAK CBO Application User Manual Draft 5 12 2010 Page 34 Defining Household Members PEAK will ask you to further define the members of the household to better determine eligibility Click in the box next to each household member that the question applies to 0 Start Blindness or Disability Please check the box for anyone who is disabled blind or unable to work because of illness or injury or anyone with special needs O EEE AET V No one
4. Review Your Answers SSI Letter Please check the box for anyone who has received a Supplemental Security Income SSI approval letter even if you haven t actually received a payment MV No one r Wysteria Forsythia Review Your Answers SSI 1619 a or b Please check the box for anyone who is getting SSI 1619 a or b benefits This program helps disabled people keep their health care coverage if they start working and are no longer able to get cash payments from SSI z Wysteria cit Forsythia CO PEAK CBO Application User Manual Draft 5 12 2010 Page 57 Completing the Application Initiation Client Rights and Responsibilities All applications in Colorado PEAK require a signature before they can be completed Before signing the application a client must read the Rights and Responsibilities agreement COLORADO Program Eligibility and Application Kit Colorado gov Colorado Dept of Human Services Colorado Dept of Health Care Policy and Financing Accessibility a f ipusa Print ke e Help d 4 eee ee 97 Complete Start Signing Your Application You re just a few minutes away from submitting your application To do so you ll need to e Read the Rights and Responsibilities we ve listed below g e Check the signature box and type your name below to sign your application Liquid Assets Rights and Responsibilities M H AAAH JR _l 4
5. a Print S Help More About Rose s Car Please tell us a little bit more about Rose s Car Year 1999 Make Ford Model Escort Is this car registered Yes No What is the primary use of the vechicle To get to work or training or for job search x How much is Rose s Car worth How much does Rose owe on this Car Other Owners Please check all boxes that apply for anyone who owns the Car with Rose If the joint owner does not live in your home please select the someone outside of the home checkbox and enter their first and last name below For more information please click the Help button Someone outside m f m i i of the home Wysteria Forsythia Add Another Does Rose have another Car Yes No Draft 5 12 2010 Page 41 Review of Other Assets Once the Other Assets section is complete you will be asked to review the information provided and have the opportunity to make any changes 56 Complete Other Assets Summary Here is a summary of what you ve told us If you would like to change your answers to any of the fields in this section whether they are shown on this summary screen or not or finish a section click on Change or Add If you would like to remove something click on Erase Start People ce O Liquid Assets Review Your Answers Vehicles Amount Change or Owed Other Owners Peace Other Assets n Car Dont Know Ch
6. CO PEAK CBO Application User Manual Draft 5 12 2010 Page 36 Completing Liquid Assets Defining Liquid Assets PEAK defines Liquid Assets as any cash bank accounts stocks bonds certificates of deposit retirement accounts 401K IRAs etc trust funds annuities etc Populate this section as completely as possible to ensure that the client will be accurately screened for benefits In our test case Rose Bush has some cash at home and a bank account but no other liquid assets For each asset listed PEAK will ask for more detail O d Liquid Assets Other Assets Job Income Other income Housing Bilis Other Bills Finish Submit O0000000 CO PEAK CBO Application User Manual Liquid Assets Next please tell us about the people in your home who have liquid assets By liquid assets we mean things like cash you are saving at home bank accounts stocks bonds certificates of deposit retirement accounts trust funds annuities etc If someone owns an asset with another person please check the box for just one owner Later we ll ask about who else owns the asset Cash Please check the box for anyone who has cash No one r Wysteria Forsythia Checking Savings Account Please check the box for anyone who has a checking savings account 7 ee Lilac Wysteria Forsythia No one Other Liquid Assets Please check the box for anyone who owns any other liquid asset Be sure
7. Employer Type How Much Hours Change or Erase a To add a job for someone in your home please choose their name and click the Add button Name click here to choose Change or Erase E an Review Your Answers On Strike Summary Pay How Haure Change or Employer Type Much Erase You ve told us that no one in your home is on strike Add a Job On Strike To add a job on strike for someone in your home please choose their name and click the Add button Name lt click here to choose gt W Add j Review Your Answers Self Employment Summary Who How Much Hours Expenses Change or Erase You ve told us that no one in your home is self employed Add a Type of Self Employment To add a type of self employment for someone in your home please choose their name and click the Add button Name lt click here to choose gt Add Review Your Answers In Kind Income Summary Who Employer How Much Change or Erase You ve told us that no one in your home has in kind income Add a Type of In Kind Income To add a type of in kind income for someone in your home please choose their name and click the Add button Name lt click here to choose Add Review Your Answers Left or Lost a Job Please check the box for anyone who left or lost a job within the last 60 days MV No one Draft 5 12 2010 Page 45 Completing Other Income Information In this section indicate if
8. e box for anyone who used to get Supplemental Security Income payments SSI but isn t ind that SSI is a monthly payment for people with very low incomes who are at least 65 or blind nt benefit and it is not the same as Social Security Progra m Eligibility P getting Sst panet his rae nek ingome went up As a result he or she is no longer able to get ry gt SI t tl that and Application Kit gt you should not check the box for that person check the box for anyone who has received an approval letter from the Social Security Administration Colorado gov Colorado Dept of Human Services Colorado Dept of Health Care Policy and Financing Accessibility y Print UG ee Close Window 84 Complete Start Other Information We re almost done just a few more questions about the people in your home People O Medicare Part A Part B or Part D Please check the box for anyone who is getting Medicare Part A Part B or Part D or who is entitled to Part 4 B or D By entitled we mean that you are able to get the benefit even if Liquid Assets you aren t actually getting it To find out more about Medicare Part 4 Part B and Part D please click the Help button Other Assets Lilac Wysteria Forsythia Other Income Health Insurance Coverage Housing Bills Please check the box for anyone in the household who is covered by a health insurance policy Other Bills QO r o
9. i i ENNA You have two choices right now Housing Bilis j wea e You can keep working on your application and set your application date when you submit your full application online N Other Bilts j By working on your application and giving more information now you can reduce Ateenaa cna temannenatnmsnacnat aein the amount of information an eligibility site worker will need to request Da m For most people the rest of the application will take about 30 minutes Finish You can always save your information and come back later is l ee J You can set your application date after we ask you just a few more questions This should take about 5 minutes Submit i If you set the application date now you will need to finish the application later with EEE an eligibility site worker from your local eligibility site What would you like to do Complete my application online Set my application date and complete my application later with an eligibility site worker CO PEAK CBO Application User Manual Draft 5 12 2010 Page 23 Some clients may be eligible for expedited food assistance services This page asks for information that will assist in making that determination Complete it with the best information you have at hand Depending upon the program various proofs of income and expenses will be required NOTE In the fictional case below Rose Bush is a single mother of three children Lilac Wysteria
10. FOR COMMUNITY PARTNERS www colorado gov PEAK Table of Contents Introduction Welcome sosuri asne s AE EO ETEA 3 Training Objectives ricuni a a toes eaee 4 HOW to Usethis Man alsisonicinsreneuro n a 4 WAY REAM cuer A E N E E 5 Pr gram OVETVIEW iwraccccesiccecteshaieaaiucsaisctavelnl a A A N 6 SESSION FIOwWcChart aione ee eee ee N 7 Gentine Started aciono a a a S EEN 8 FNAME PEAK orioa a a a N aac cee 8 L ginN to PEAK anciana E a 13 B fore You ot 21 4 9 eee en Cee ene n A a o or EAE 16 Starting an Application seessessesssnssssssssossocecoeseessosse so iae vas cnacescensracnsconsenscessccnsaccaensaserscenses 20 Review of Start Information ccccccscccscsscsessscssces MiiasesMee res ene ene e NE o o eseese ressuessescsccssnecsscsecesscsssesssees 26 Populating People in the Household ssesossosseossoesoesseesseeseeseeceecseccseooesossseesosecsecsscossoessossoesossseeesseoseo 28 Populating Additional People in Household ssesossooseossoesoeeseeccecoeeoossossoossseeseeeseeoseoseosecessse 30 Indicating Pregnancy ssesseessessonssess ee Ehe ccc sserosssssesesacesecsocecos sees MEND se ses ccesesssessossonsssssssseos 31 Determining Household Relationships ccscsscsscescesceeceecesccecceccessssessscessescesceeceecescenseeses 32 Defining Household Members e seesseeseesseeseeceeosescossoesoesseeseesseeseeoseceesoossossceceseesseoseossoeseosscesseeo 35 Completing Liquid Assets
11. If you would like to remove something click on Erase i Liquid Assets Review Your Answers Housing Bills What Bills How Much Change or Erase a a OT Add a Housing Bill Job Income To add a housing bill please select the type of bill then click the Add button Type click here to choose gt Other Assets Other Income Review Your Answers Utility Bills Housing Bills What Bills How Much Change or Erase Electric not cool heat Change or Erase Natural Gas Change pr Erase Other Bills Add a Utility Bill Finish To add a utility bill please select the type of bill then click the Add button Type lt click here to choose gt Submit 00000000 m Review Your Answers Other Questions 7 Here are your answers to the other questions in this section Please take a look and make sure your answers are correct If they aren t correct you can check or uncheck the boxes to change your answers m Room and Meals Please check the box for anyone who pays for a room and meals No one Rose Lilac Wysteria Forsythia Review Your Answers Housing Assistance Does your household get Rausing or tank Secicaricee Yes Public Housing Yes Rent Assistance No If your household gets Public Housing Assistance do you get a separate bill for utilities C Yes No 4re all utilities included in the rent Yes No Review Your Answers Temporary
12. processes There is a link to download Adobe Acrobat if you don t have it on the computer you are using Print Your Application If you would like to print a copy of your application for your files please click the Print My Application button If you decide to print please keep in mind that your application has your private personal information in it Keep in mind that you ll need to have a program called Adobe Acrobat Reader to see and print this information If you don t have this program on your computer you may install it for free by clicking on the button below If you would like to register to vote please click here Keep in mind you can come back later to PEAK to view your submitted application UH Exit Make sure you exit out of the online application when you have completed the application with the client CO PEAK CBO Application User Manual Draft 5 12 2010 Page 66 Next Steps Completing the Application Process Hitting Submit in PEAK just starts the application process There are a few more things that applicants will need to do to complete their application It is important that they understand that submitting the application is the just part the first part of the process What do applicants have to do next The documents that support what has been disclosed in the application will need be submitted If everything has been submitted with the application then the eligibility technician
13. 999 faz z 2199 Is this person a U S citizen ce C CO PEAK CBO Application User Manual Draft 5 12 2010 Page 30 Indicating Pregnancy Pregnancy is a key determinant for beginning medical benefits immediately If a client is pregnant please indicate it on this screen NOTE Colorado PEAK will automatically screen the ages of women on the application and will only ask about pregnancy for those women over 10 years old There is no top end age cut off COLORADO Program Eligibility and Application Kit Colorado gov Colorado Dept of Human Services Colorado Dept of Health Care Policy and Financing Accessibility vanns 1 Bay gg Print Ls e _Help j 5 weens ammi ai i m 15 Complete Pregnancy Information Next we need to know if anyone in your home is pregnant Pregnancy Please check the box for anyone in your home who is pregnant Start People Liquid Assets V No one Other Assets E Ei Job Income Other income 000000 Housing Bills CO PEAK CBO Application User Manual Draft 5 12 2010 Page 31 Determining Household Relationships Understanding the relationships within the household is important for determining benefits i e food assistance PEAK will ask you to clarify how the members of the household are related if at all The relationship between the Head of Household and each person on the application will be asked first Select the option from the drop down menu that bes
14. Exit Next Other Bilts NOTE Enter only the amount of rent paid to the landlord here If the client pays for utilities separately do not add those costs into the rent COLORADO Program Eligibility and Application Kit Colorado gov Colorado Dept of Human Services Colorado Dept of Health Care Policy and Financing Accessibility es t e o paag Print le ssa ialp 71 Complete ey star Rent Payment You ve told us that the household makes Rent payments Please answer the questions below to tell us more about this payment How much is your household supposed to pay for Rent each month l 400 00 peapa Back Save amp Exit Next EY CO PEAK CBO Application User Manual Draft 5 12 2010 Page 49 Indicate what utilities the client is responsible for in addition to their rent payment COLORADO Program Eligibility and Application Kit Colorado gov Colorado Dept of Human Services Colorado Dept of Health Care Policy and Financing Accessibility tee ee ae J 73 Complete Start Utility Bills Please check all boxes that apply for all of the utility bills that the household is responsible EY roe for paying Utility e a a Butane Cooling Heating Other Cooling kai Liquid Assets Electric not Coal v ET EP Firewood V Natural Gas Garbage trash Heating Oil Other Assets Other Heating Phone Propane Sewer Septic Tank Utility
15. If you would like to change your answers to any of the fields in this section whether they are shown on this summary screen or not or finish a section click on Change or Add If you would like to remove something People click on Erase Liquid Assets Review Your Answers Medicare Summary Premium PRO Change or Erase Who Type You ve told us that no one in your home gets Medicare PartA B or D Add Medicare Benefits To add a person s Medicare benefits please choose their name and click the Add button Name lt click here to choose z Add Housing Bills Review Your Answers Health Insurance Coverage Policy Insurance Who is C Holder Company CEEA hange or Erase You ve told us that no one in your home is covered by a health insurance policy Add a Health Insurance Policy To add a health insurance policy choose the name of the person who holds the policy Then click the Add button Name lt click here to choose Add Review Your Answers School Enrollment Enrollment Status Review Your Answers Health Insurance Please check the box for anyone who has lost health insurance coverage within the last 3 months V No one 7 Wysteria Forsythia Review Your Answers Previous SSI Benefits Please check the box for anyone who used to get Supplemental Security Income SSI but is no longer getting this benefit V No one T i Wysteria Forsythia
16. Please read the following information carefully We also suggest that you print out your application on the next page so you have a copy of this information Other Assets I UNDERSTAND AND AGREE THAT It is a crime to lie on this application Benefits will be denied if any information on this application is found not true or if requested information is left off the application If any information that I provide is incorrect my application may be denied and I may be subject to criminal prosecution for knowingly providing incorrect information For Colorado Works TANF medical assistance programs and adult financial cases I must inform the agency within 10 days of any changes to my case For Food Assistance I am required to report changes that are required to be reported within the first ten days of the month that follows the month in which the change occurs Job income Other Income Housing Bills 00000 CO PEAK CBO Application User Manual Draft 5 12 2010 Page 58 Requesting to Waive the In Person Interview Clients are given an explanation of the interview process and asked how they would like to be contacted about the application At this point they can request an interpreter if one is necessary for the interview Your Interview In some cases people who are applying for benefits have an in person interview with an eligibility site worker Please keep in mind that if you are applying for cash benefits for
17. Please tell us a little bit more about Rose s checking saving accounts What is the value of Rose s checking saving accounts l 200 People I Don t Know Liquid Assets Bank or Company Please tell us about the bank or company that holds Rose s checking saving accounts Other Assets Name of bank or company Maple Tree Bank Address City State Zip Code Job Income Boulder Colorado z e0304 What are the last two digits of a Rose s account number Other Income Other Owners Please check all boxes that apply for anyone who owns the checking saving accounts with Rose Housing Bills If the joint owner does not live in your home please select the someone outside of the home checkbox and enter their first and last name below For more information please click the Help button Other Bills Finish f f Someone outside zat m of the home Lilac Wysteria Forsythia Submit O00000 00 Add Another Does Rose have another checking saving accounts jaa was eal ata CO PEAK CBO Application User Manual Draft 5 12 2010 Page 38 Review of Liquid Assets Before proceeding to the next section of the application PEAK will ask you to review the answers given in the Liquid Asset section of the application Make any changes using the Change link in each table COLORADO Program Eligibility and Application Kit Colorado gov Colorado Dept of Human Services Colorado Dept of
18. V Family and Children s Medical Assistance If you are looking for medical assistance for your family applying on behalf of a child or are pregnant check this box Otherwise click on the following link for more information about other public medical assistance programs Department of Health Care Policy and Financing Some medical assistance programs can help with paying medical bills from the past three months If you want your benefits to start in a month that has already passed please check the box for that month January February March WV Cash Assistance Citizenship Information Keep in mind that you don t have to answer these questions if this person is not asking for benefits Social Security Number 123 45 678 Is this person a U S citizen Co Yes G No Ethnicity You don t have to answer these questions if you don t want to Your answers will not be used to make a decision about your benefits Please check the box or boxes to tell us this person s race national origin ethnicity American Indian Alaskan Native Asian Black African American Native l Hispanic Latino M Hawaiian Other Other Unknown Pac Isl WV White Residence Information Is this person a resident of Colorado co Yes C No Does this person plan to stay as a resident of iy Yes C No Colorado Is this person a migrant worker C Yes ce No click here to choose gt z Qei saves exit neat EY ere does
19. of Human Services Colorado Dept of Health Care Policy and Financing Accessibility To return to the application you will need to log back into the application as shown on Page 15 of this guide Once you have successfully logged back in you will be asked if you would like to go back to where you stopped filling out the application or if you would like to submit the application COLORADO Program Eligibility and Application Kit Welcome Back 7 ease click one of the buttons to tell us what you would like to do Then click the Next button at the bottom of the page Go back to where you stopped filling out the application Submit your application If you choose to go back to where you left we ll take you to the next page that needs to be filled Keep in mind that you can click on the section buttons for example Job Income that will appear on the left side of the screen to go back to sections you have finished If you want to start a new application or check the status of an application you have already submitted click the Back button to go back to the Welcome page wack nex CY Colorado Dept of Human Services Colorado Dept of Health Care Policy and Financing Accessibility Cc oO ora d oO g DY CO PEAK CBO Application User Manual Draft 5 12 2010 Page 19 Starting an Application The first step is to determine which program s is appropriate to meet the applicant s needs Colorado PE
20. Al The city sits at the foot of Pikes Peak America s mountain R encompasses 194 square Colorado gov Colorado PEAK Program Eligibility and W Wikipedia oa a ae oa lo or The Colorado PEAK is a Web based portal designed to provide citizens and community z www pikespeakcolorado com Cache partners with a modem and easily accessible tool to apply for public Mountain peaks of Colorado Wikipedia the free encyclopedia www colorado gov benefits Similar Highest major Most Most isolated Gallery This article comprises three sortable tables of the major mountain 14ers com Home of Colorado s Foureeners and High Peaks peaks of the U S State of Colorado Main article Table of the z Colorado Fourteeners Thsteeners Routes Tap Reports and more _ The largest collection of highest major summits of Colorado 14er and 13er photos on the Web en wikipedia org wiki Mountan_peaks_of_Colorado 4 www 14ers cami Similar Caiit Peake Pikes Peak Country Attractions Colorado Activities On the Colorado Peaks page 1992 peaks above 9050 feet ara marked as USGS peak Official website of Pikes Peak Country Attractions Association See Pikes Peak and over 50 Peaks from non USGS sources are also included and they may be lower altitude area attractions with the entire family www climber org data peaks COpeaks him 790k Cached www pikes pesk com Similar 14ers com The Home of Colorado s Highest Peaks j Contains pictures of Colorado
21. Health Care Policy and Financing Accessibility w p E a a gang Print ke e Help a 36 Complete O Start Liquid Assets Summary Here is a summary of what you ve told us If you would like to change your answers to any of the fields in this section whether they are shown on this summary screen or not or finish a section click on Change or Add If you would like to remove something click on Erase i Liquid Assets Review Your Answers Other Liquid Assets Bank Other Change Taner Erp BSUS Company Owners or Erase Other Assets You ve told us that no one we asked about has any other liquid assets Job Income Add a Liquid Asset To add a liquid asset please choose the name of the owner and the asset type Then click the Add button Other Income Name Type click here to choose click here to choose gt h Housing Bilis Review Your Answers Cash Other Bilis Who Has It Amount Change or Erase Change or Erase Finish Submit Add a Person Who Has Cash To add a person in your household who has cash please choose their name Then click the Add button O00D0D0000 Name click here to choose Bank Other Change or Company Owners Erase Change or Erase Add a Checking Savings Account To add a checking savings account please choose the name of the owner and then click the Add button Name lt click here to choose Colorado gov Colorado De
22. Liquid Assets Other Assets Wysteria Food Assistance or Cash Assistance Disqualificatio Please check the box for anyone disqualified from Food Assistan T Cj H E f Lilac Wysteria Job Income V No one Other Income Housing Bilis Forsythia Other Bills Avoiding Prosecution Please check the box for anyone trying to avoid prosecution or jail for a felony Finish V No one Probation Parole Please check the box for anyone who is violating a condition of probation or parole V No one CO PEAK CBO Application User Manual Draft 5 12 2010 Page 35 Drug Felony Conviction Please check the box if anyone in your household has been convicted of a felony under Federal or State law for possession use or distribution of a controlled drug substance felony drug conviction or for a crime committed while under the influence of controlled drug substance after August 22 1996 V No one E g Access to State Benefits Please check the box for any child that has either a parent or legal guardian that works for a Colorado state government agency and has access to State health benefits T 7 Wt Rose Lilac Wysteria Forsythia V No one Immunization Shots Please check the box for anyone whose immunizations are up to date V No one Lilac Wysteria Forsythia Colorado gov Colorado Dept of Human Services Colorado Dept of Health Care Policy and Financing Accessibility
23. Why PEAK According to U S Census Bureau figures more than 35 billion in federal funds are going unclaimed each year This figure includes e Tax Refunds Additional Child Credit Child and Dependent Credit Child Tax Credit and Earned Income Credit e Food and Nutrition Program funds e Health Care and Prescription Drug Program funds e Energy Assistance Program funds e Child Care Support Program funds Additionally the state of Colorado consistently ranks in the bottom 10 of key indicators of poverty e Colorado currently ranks 4g in the nation for children s health coverage e 804 462 Coloradans are currently uninsured and over half 418 108 are living below 200 of the federal poverty level and would most likely be eligible for public health coverage e 334 069 children in Colorado are eligible but not enrolled in Medicaid or CHP e Colorado ranks 30 in the nation for the percentage of overall population living below the federal poverty level o 1 015 950 Coloradans live below 200 of the federal poverty levels o 362 230 Coloradans live below 250 of the federal poverty levels e Colorado ranks 48 in the nation for food assistance SNAP enrollment with just 54 of those eligible Coloradans actually enrolled in the program e Only 40 of working poor in Colorado who are eligible for food assistance are enrolled e The child poverty rate in Colorado has grown by 72 since 2000 this is the fastest growing ra
24. and Forsythia She is working part time and we have used her income and expense information for the application Colorado gov Colorado Dept of Human Services Colorado Dept of Health Care Policy and Financing Accessibility a f 11 Complete Start m Getting Faster Service Some people may be able to get faster service for Food Assistance The questions on this page will help us see if you can get this faster service If you re unsure of the exact amount for any of these questions please just make your best estimate We will ask for more detailed information later in the application Liquid Assets Food Assistance Have you received Food Assistance this month Yes No Other Assets r Income Please be sure to count all income from jobs and sources other than jobs such as Social Security unemployment or child support Be sure to count all income that comes in during Job Income this calendar month even if the source of the income like a job or benefit payment has stopped People PR y e A 4 What is the total amount of money the people in your home will get this month We need to know the total gross monthly income which is the 1280 00 amount before taxes or anything else is taken out of your household s aychecks or benefit checks Other income O 8 ft Housing Bills Liquid Assets What is the total value of any assets that belon
25. as well as the bills you pay each month for housing utilities and child care If you d like to see a list of the items you may want to gather before you start your application Click here Once you finish answering these questions your application will be handled by an eligibility site a Before you can get benefits the eligibility site may need to get proof of some of the answers you have given In so cases you will also need to talk with an eligibility site worker over the phone or in person Your local eligibility site will call you or send a letter about this You have the right to have another person apply for benefits for you This person is called your Authorized Representative or AR You ll have a chance to appoint an AR later in this application gov Colorado Dept of Human Services Colorado Dept of Health Care Policy and Financing Accessi ons about the status of your online application please contact your local eligibility site If yo n z gt AaAD WARNING A Your PEAK session will expire in 0 02 minutes You can keep your session active by clicking the Yes button below Cancel yoo ETTET TT IT g ga STT rut solic e types o f that you nay eps to provide Click the Types 7 bof button to see and el CO PEAK CBO Application User Manual Draft 5 12 2010 Page 16 Before you ge our application there are a few things you should know Please keep in you do not have an
26. choose the Log in option and proceed directly to the log in page shown on page 15 CO PEAK CBO Application User Manual Draft 5 12 2010 Page 13 2 Complete the login information on the next screen COLORADO Program Eligibility and Application Kit Colorado gov Colorado Dept of Human Services Colorado Dept of Health Care Policy and Financing Accessibility otomaly o A Ce aHoipi Setting Up Your Account When you re done with these three steps click on the Create Account button at the bottom of the page Step 1 Your Name Please fill in your name below Some items have a star next to them You must fill these iterns before you can go on to the next page i LADE Middle Initial Last Name Step 2 User Name and Password To log into the Apply for Benefits you will need to create a user name and password For both of these you should choose something that is easy for you to remember but hard for others to guess Please write down the details on a paper and keep it in a safe place This must be 5 to 20 letters and or numbers m Passwords must be between 8 to 24 characters Passwords must contain at least 3 of the 4 items below 1 One Uppercase Character 2 One Lowercase Character 3 One Number 4 One Special Character Special Characters include items such as and_ Please re type your Password Password Step 3 Secret Question We re also as
27. etc c Yes ce No If yes please list Finish First Name Middle Initial Last Name Submit First Name Middle Initial Last Name First Name Middle Initial Last Name Has this person previously received benefits in any other state Yes ce No If Yes please indicate the program Food Assistance I Cash Assistance Family and Children s Medical Assistance If in another state which state did this person receive benefits lt click hereto choose Si in What is the last date this person received benefits Program Selection Please check the box for each program this person would like to apply for If you don t check a box this person will not be applying for that program V Food Assistance Family and Children s Medical Assistance If you are looking for medical assistance for your family applying on behalf of a child or are pregnant check this box Otherwise click on the following link for more information about other public medical assistance programs Department of Health Care Policy and Financing Some medical assistance programs can help with paying medical bills from the past three months If you want your benefits to start in a month that has already passed please check the box for that month January February March IV Cash Assistance Citizenship Information Keep in mind that you don t have to answer these questions if this person is not asking for benefits Social Security Number
28. individual child and family in Colorado is screened for and enrolled in the health nutrition and financial self sufficiency benefits that help them thrive It has been designed with you in mind the success of PEAK relies on your participation in reaching out to and encouraging potential clients to apply The primary goal of this training manual is to provide you with the knowledge and skills necessary to feel comfortable and competent in assisting clients in using the PEAK online application form It is important that we always keep focused on the benefits of using PEAK for the applicant These include e Providing 24 hour access to the online screener application form benefits checker and reporting functions e Ability to apply when it is convenient saves non submitted application data for 30 days e Allows applicants to avoid perceived stigma by applying from a known comfortable environment such as their home a library or community organization Acts as a single application to access multiple programs Allows clients to apply for benefits with you a person they know and trust Creates efficiencies for counties improving timeliness and customer service Informs clients of the necessary documentation they may need to complete the application empowering them to manage their information Your help is critical in providing that link between your clients and the health coverage food and cash assistance programs that may assist them in m
29. m County Eligibility Site Locations and PEAK Contacts CO PEAK CBO Application User Manual Draft 5 12 2010 Page 62 The list of documents that may be used as proof of the information provided on the application is linked to using the Types of Proof button NOTE The types of proof listed here is a general list For detailed information on which documents may be used to support each program in PEAK consult the Program Overview and Quick Reference Guide supplied with this manual COLORADO Program Eligibility and Application Kit Colorado gov Colorado Dept of Human Services Colorado Dept of Health Care Policy and Financing Accessibility _ A tpg _Print P Help at eeee cece cee 100 Complete Thank You Thank you Your online application has been sent to a local eligibility site office If you have questions about the status of your online application please contact your local eligibility site If you give your online tracking number it can help you get answers more quickly Here is how you can find your local office For applications that are only for Family and Children s Medical Assistance click here For all other applications click here If you haven t heard back about an online application you ve submitted please be sure to contact your local eligibility site before submitting another online application Keep in mind that your eligibility site worker may ask for proof of some of the things you
30. to check the box if you own retirement accounts trust funds other than burial trusts stocks bonds certificates of deposit annuities etc V No one Wysteria Draft 5 12 2010 Page 37 Because Rose Bush indicated that she has some cash and a bank account PEAK will ask for more detail about these liquid assets Indicate if the assets are co owned by anyone else either in the household or not at this point COLORADO Program Eligibility and Application Kit Colorado gov Colorado Dept of Human Services Colorado Dept of Health Care Policy and Financing Accessibility pma Print Piede Le Mo hisin 35 Complete Q amp Start More About Rose s Available Cash Please tell us a little bit more about Rose s available cash Peopl What is the value of Rose s available cash 4 100 00 I Don t Know Liquid Assets Other Owners Please check all boxes that apply for anyone who owns the available cash with Rose If the joint owner does not live in your home please select the someone outside of the home checkbox and enter their first and last name below For more information please click the Help button Job Income f E f E Other Income Other Assets oO Someone outside of the home Lilac Wysteria Forsythia Housing Bilis Back Save amp Exit Next S pma Print eo Heip 35 Complete Start More About Rose s Checking Saving Accounts
31. told us in your application We ve created a list of the types of proof that you may need to provide Click the Types Of Proof button to see and print this list __ Types Of Proof ies gs noe Sandh mmei sesh mmesoetos tivemacses sarees Ss You may also need to talk with an eligibility site worker by phone or in person For Food Assistance you must talk with an eligibility site worker in order to get benefits CO PEAK CBO Application User Manual Draft 5 12 2010 Page 63 The general list of documents that may be needed to be verified by the eligibility site includes NOTE This list may be printed out and handed to the client so that they have the information they may need to complete the application process m Types of Proof We need to find out some things to see if you can get assistance Some information can be verified by your statement at the interview Other information may need to be verified by giving us proof Proof is the way you show us what we need to know In some cases proof must be received before your application for assistance can be completed Below is a list of items that can be used as proof If you can t get the proof let your eligibility site worker know Your worker may be able to help you C Proof of Identity Your identification such as picture ID or drivers license a Proof of Assets Proof of resources assets such as checking savings vehicles CD s IRA s stocks life insurance burial p
32. AK allows clients to apply for individual programs or to complete a general application for all programs available in PEAK NOTE PEAK is designed to ask only those questions that are pertinent to the programs for which a person is applying By selecting the All programs option the client will be asked to complete the most comprehensive application form NOTE There are a number of human services benefit programs that are available that a client cannot apply for using PEAK If you are working with an individual or family that has other needs please direct them to their county office for further assistance COLORADO Program Eligibility and Application Kit Colorado gov Colorado Dept of Human Services Colorado Dept of Health Care Policy and Fin 5 Complete Start Which Benefits Would You Like to Apply For The first step is to tell us which benefits your household would like to get Please check the box for each benefit your household would like to apply for Later you will have the opportunity to select specific programs for each person in your home as you complete the People application Click the Next button at the bottom of the page to continue a Food Assistance Food Assistance benefits come on a plastic card called Colorado Quest Cards which you can use to buy food at most food stores Liquid Assets Family and Children s Medical Assistance If you are looking for medical assistance for your family apply
33. Costs Utility P Job income Trash a Installation Fee Water Wood Are all utilities included inthe rent Yes No Other Income Back Save amp Exit Next EY Q Housing Bilis CO PEAK CBO Application User Manual Draft 5 12 2010 Page 50 Based on the utilities that were checked in the previous screen PEAK will ask for details regarding the utility bills that the client pays on a monthly basis Since Rose Bush indicated that she pays for natural gas and electricity PEAK will only ask for details about those two utility bills COLORADO Program Eligibility and Application Kit Colorado gov Colorado Dept of Human Services Colorado Dept of Health Care Policy and Financing Accessibility l P Print Le e F wed eT 74 Complete O Start Electric not cool heat Payment You ve told us that your household pays for Electric not cool heat Please answer the questions below to tell us more about this payment If you don t pay for this each month please estimate what it costs on a monthly basis How much does the Electric not cool heat cost each month 4 25 00 Liquid Assets What is the name of the company provider or landlord you Exsel pay for this utility If this bill is not in a household member s name what is the 4 Other Assets customer s name on the account ee Back Save amp Exit Next P Job income MR Apep TE EDA Seeders COLORADO Program Eligibility and A
34. Shelter Expenses Have you paid for any ternporary shelter costs this month C Yes No If Yes what was the amount paid 4 Colorado gov Colorado Dept of Human Services Colorado Dept of Health Care Policy and Financing Accessibility CO PEAK CBO Application User Manual Draft 5 12 2010 Page 52 Completing Other Bills Information If there are other bills that the client is paying relating to care for either a child or an adult child support that the client must pay out or monthly medical costs indicate those expenses here 77 Complete Start Your Other Bills Next please tell us about some of your other bills People i i Child or Adult Care Bills Please check the box for anyone who pays someone to care for a child or adult who is living in your home Keep in mind that you should only check the box if the person pays for care Liquid Assets so they can accept or continue employment attend training or education which is needed for employment or for Employment and Training E amp T requirements Other Assets Job Income Other Income Child Support Obligations Housing Bills Please check the box for anyone who makes child support payments to someone living in another household Other Bills Finish Submit 0000000000 Medical Costs Please check the box for anyone who has monthly medical costs By medical costs we mean doctor bills medicine insurance premiums transportation to medical servic
35. a family which includes a dependent child a face to face interview is required You will be contacted by your local eligibility site with the time and date of your interview Please indicate how you would like to be contacted Phone If an interview is necessary and you need an interpreter English X please select a language Clients may also ask to be exempt from an in person interview They may be eligible to waive the in person interview if they can prove hardship caused by coming into the county or medical vendor office Request to Waive the In person Interview If you prefer to talk with an eligibility site worker over the phone please check the box to tell us what makes it hard for you to come to the local eligibility site I am over the age 60 I am disabled I am employed more than 20 hours a week I have a child under 6 years of age I I do not have childcare I have no means of transportation I am caring for others Other m CO PEAK CBO Application User Manual Draft 5 12 2010 Page 59 Selecting an Health Maintenance Organization It is important that the client selects a Health Maintenance Organization HMO If a client is unsure which HMO to select choose an option This decision can be changed later NOTE It is extremely important that any client with children who may qualify for CHP select an HMO Select an HMO Provider To receive health care insurance by CHP you must choose 4 Health Ma
36. aintaining or becoming self sufficient Your role can encompass Promoting Colorado PEAK in your facility Actively directing potential clients to the online screener and application Providing assistance to individuals or families as they complete an online application Guiding clients through the overall application process and assisting them with gathering the necessary documentation Sree i T We want to give you the skills needed to accomplish these goals and this manual will serve as your reference guide when questions arise We hope that you find it helpful and know that Colorado PEAK has been designed as another resource to help you serve your clients and communities Thank you The Colorado PEAK Outreach Team CO PEAK CBO Application User Manual Draft 5 12 2010 Page 3 Training Objectives When you complete this training you will e Understand how PEAK can assist clients in securing medical food and cash assistance benefits e Understand your roles and responsibilities as a CBO partner of PEAK e Learn details of the programs that can be accessed using PEAK e Initiate a benefits application using the PEAK online software o Navigate to and log onto PEAK o Create a client account o Initiate an application o Submit an application electronically o Print an application e Assist clients in completing the application process o Review next steps About This Manual CO PEAK CBO Application User Manual Draft 5 12 2010 Page 4
37. als together Because they may be minors who don t actually buy the food a client may be tempted to answer no Pose the question differently and ask if the additional household members usually eat their meals together COLORADO Program Eligibility and Application Kit Colorado gov Colorado Dept of Human Services Colorado Dept of Health Care Policy and Financing Accessibility e o gag Print lgo Hebe 16 Complete Start How You Are Related Please tell us how the people in your home are related to each other People Lilac s Relationship to Wysteria f lis the Sister of f Lilac Wysteria Liquid Assets Other Assets Does Lilac purchase and prepare meals with Wysteria Yes No i Lilac s Relationship to Forsythia f i Lilac Forsythia Job Income Other Income 000000 Does Lilac purchase and prepare meals with Forsythia Yes No a ra S Housing Bilis ies Sissit An Sale teks Other Bills CO PEAK CBO Application User Manual Draft 5 12 2010 Page 33 For households where minor children do not live with both parents PEAK will ask for the missing parent s information COLORADO Program Eligibility and Application Kit Colorado gov Colorado Dept of Human Services Colorado Dept of Health Care Policy and Financing Accessibility 18 Complete e png Prine d En
38. ancing Accessibility pains pang _Print 1 t e Help 69 Complete Start Room and Meals LL check the box for anyone who pays for a room and meals No one EY ro Liquid Assets P 5 A a it Lilac Wysteria Forsythia Other Assets Temporary Shelter Expenses Have you paid for any temporary shelter costs this month Job Income l If Yes what was the amount paid g Other income Q Housing Bills CO PEAK CBO Application User Manual Draft 5 12 2010 Page 48 COLORADO Program Eligibility and Application Kit Colorado gov Colorado Dept of Human Services Colorado Dept of Health Care Policy and Financing Accessibility R j Cap Pent gg Neate catia ees entrees 70 Complete Start Housing Information Please check the box for all the housing bills that the household is responsible for paying People O m Housing Bills I Insurance Premiums Free Shelter Free Utilitie Liquid Assets nome Owner Assoc Mandatory Fees l Mortgage Interest Other Contribution amount Property Taxes amp T Mortgage E paid a Assessments Other Assets V Rent Meals r Housing Assistance Job income Does your household get housing or rent assistance Yes Public Housing Yes Rent Assistance No P Other Income If your household gets Public Housing Assistance do you get a separate bill for utilities Yes No Housing Bills Back Save amp
39. ange or Erase Job Income Rose Add a Vehicle If someone else in your home has a vehicle please choose the name of the owner and the type of vehicle Then click the Add button Owner Type alue Other Income Housing Bills Name Type click here to choose x click here to choose gt Add Other Bilts Review Your Answers Real Estate Finish Owner Type Address Other Owners cange ar You ve told us that no one we asked about owns any Real Estate Submit Add a Type of Real Estate If someone else in your home owns real estate please choose the name of the owner and the type of real estate Then click the 4dd button Name Type click here to choose click here to choose gt x k Add d Review Your Answers Burial Assets Owner Type For alue Change or Erase You ve told us that no one we asked about owns any burial assets Add a Burial Asset If someone else in your home owns a burial asset please choose the name of the owner and the type of burial asset Then click the Add button Name Type click here to choose click here to choose gt z Add Review Your Answers Life Insurance Is this life insurance Face Yalue Insurance Change or Term or Whole of Policy Company Erase You ve told us that no one we asked about owns any life insurance assets Add a Life Insurance Policy Owner If someone else owns a life insurance policy please choose the name of the own
40. ate Hours per week click here to choose gt z sl Type of pay Hourly rate Hours per week click here to choose gt z r Type of pay Hourly rate Hours per week click here to choose gt z sl Tip Bonus or Commission Pay If Rose gets any other pay such as tip bonus or commission pay please tell us the type of pay Rose earns and the amount per week If the amount is not regular try to estimate the average amount that Rose gets Type of pay mount per week click here to choose gt z 4 Type of pay Amount per week click here to choose gt z 4 Type of pay Amount per week click here to choose gt z sl Does Rose have any other jobs Yes No CO PEAK CBO Application User Manual Draft 5 12 2010 Page 44 Review of Job Income Once the Job Income section is complete you will be asked to review the information provided and have the opportunity to make any changes 61 Complete Start People Job Income Other Income Housing Bills Other Bills Finish Submit 0000000000 CO PEAK CBO Application User Manual Job Income Summary Here is a summary of what you ve told us If you would like to change your answers to any of the fields in this section whether they are shown on this summary screen or not or finish a section click on Change or Add If you would like to remove something click on Erase Review Your Answers Current or Recent Job Summary
41. ated to them If they aren t related but share food together be sure to count them If they aren t related and they don t share food together you don t have to include them 14 Complete People In Your Home You have already told us about the following person Start People Liquid Assets Rose Please provide more information about Rose Other Assets People in the Home How many people are in your home Don t forget to count yourself Job Income If you re not sure Click here to read more about what we re asking for O000000000 0 Other Income Personal Information First Name Middle Initial Last Name Jr Sr etc Rose Bush M Housing Bilis Gender Male Female i Other Bills Date of Birth 08 17 1966 What is this person s marital status Divorced Finish What language does this person prefer to use English Has this person ever used another name such as maiden Submit name alias etc Yes C No If yes please list First Name Middle Initial Last Name First Name Middle Initial Last Name First Name Middle Initial Last Name Has this person previously received benefits in any other state Yes C No CO PEAK CBO Application User Manual Draft 5 12 2010 Page 28 Program Selection Please check the box for each program this person would like to apply for If you don t check a box this person will not be applying for that program Food Assistance
42. ation User Manual Draft 5 12 2010 Page 21 NOTE The indicates the information that is required to be able to move to the next page of the application form We recommend that you complete all the fields if the information is available Information About You First Name Middle Initial Last Name pC PO Gender Male Female Date of Birth Ex mmfdd yyyy In our test case below the Date of Birth was not entered in the correct format Before you can proceed with the application form this data must be corrected 6 Complete Before you go to the next page x Error Please be sure that the date you entered for Date of Birth Ex mom dd yyyy is in this format MM DD YYYY For example January 10 2006 should be entered as 01 10 2006 Other Assets Date of Birth aae Ex mm dd yyyy Spaz 72068 O Start Getting Started Let s get started on the application First please give us some basic information about you People Information About You First Name Middle Initial Last Name Jr Sr etc Liquid Assets Rose Bush Gender Male Female CO PEAK CBO Application User Manual Draft 5 12 2010 Page 22 If a client doesn t feel comfortable using PEAK on their own they can work with a county Eligibility Technician to complete an application If you feel as though a client s case is too involved for you to handle you can arrange for an interview for
43. d If this job recently ended or is going to end please tell us the end date of the job What is the end date of this job When was the last paycheck check received from C Rose s job Housing Bilis Other Bills Pay Period Finish How often does Rose get paid This is Rose s pay period weekly z When was the most recent paycheck received 04702 2010 Submit 00000000 Hourly Pay If Rose gets paid by the hour please tell us the amount that Rose gets paid each hour Please give us Rose s regular rate of pay We ll ask about 4 10 00 overtime and other kinds of pay below Please tell us how many hours Rose works each week at this rate If Rose s hours are not regular try to estimate the number of hours he or she usually 32 works at this hourly rate Salary Pay Please tell us the total gross pay that Rose gets paid each pay period By gross pay we mean the amount Rose earns before taxes or anything else is _ taken out of the paycheck By pay period we mean the time between each aycheck Additional Pay If Rose gets any additional pay such as overtime holiday shift or weekend pay please tell us the type of pay Rose earns the hourly rate and how many hours per week at this rate If Rose s hours are not regular try to estimate the number of hours he or she usually works at this rate of pay Type of pay Hourly rate Hours per week click here to choose gt z f Type of pay Hourly r
44. do Map Colorado Peaks Colorado Peaks Pass Fourteeners of Colorado Pyramid Peak Colorado Longs Peak Colorado Colorado Maps Peak to Peak Scenic Byway Map The Detailed Colorado map of the Peak to Peak Scenic Byway Includes idaho Springs Allenspark Estes Park Nederland amp much more wwew coloradodirectory com maps peak htmi Cached page Yuan Dan SE ARC HISTOR colorado PEAK PEAK Parent PEAK Parent Center is Colorado s Parent Training and Information Center PEAK serves parents and teachers of children with learning disabilities physical disabilities and www peakparent org aboul asp Cached page PEAK Parent PEAK Parent Center 611 North Weber Street Suite 200 Colorado Springs CO 80903 Phone 719 531 9400 Hotline 1 800 284 0251 Fax 719 531 9452 e mail nfo peakparent org www peakparent org Cached page Colorado Peak to Peak Trail and Wilderness Links Colorado Peak to Peak Trail and Vildemess Links A hand indexed directory of thousands of Hiking Backpacking Walking Trail and Wilderness Web Sites from around the world www peaktopeak netico him Cached page SummitPost Colorado Mines Peak Climbing Hiking Page Type Mountain Rock Location Colorado United States North America Lat Lon 39 79614 N 7 105 76229 W Actnities Hiking Season Spring Summer Fall Winter CO PEAK CBO Application User Manual Draft 5 12 2010 Page 8 gt colorado PEAK AOL Search Results Windows Int
45. e Policy and Financing Accessibility Please Log In Please log in using your User Name and password If you have forgotten your User Name or password click here User Name rosebush Password jeeeeeeses Colorado Dept of Human Services Colorado Dept of Health Care Policy and Financing Accessibility CO PEAK CBO Application User Manual Draft 5 12 2010 Page 15 Before You Begin the Application Once an account has been created and logged into applicants will be directed to a page that explains some of the functionality of the PEAK online application tool PS mn a gt do Dept of Human Services Colorado Dept of Health Care Policy and Financing Accessibility L NN Help With Using a Computer If you would like to practice before you get started click here Apply For Benefits Before you get started on your application there are a few things you should know Please keep in mind if you do not have any activity on this site for 15 minutes or longer you will be asked to log back in to access your Application Any information that has not been saved will be lost Please note as you move from one screen to the next via the Next button your information will be saved up to that point Inthis application we will ask you questions about the people in your home your money and your bills To answer these questions it s a good idea to have your pay stubs or benefit check stubs with you
46. e information about other public medical assistance programs Department of Health Care Policy and Financing Some medical assistance programs can help with paying medical bills from the past three months If you want your benefits to start in a month that has already passed please check the box for that month January February March WV Cash Assistance Some families and individuals can get cash help e Low income families with at least one dependent child and or pregnant woman in the home OR e Low income persons age 60 or older e Persons receiving SSI e Persons disabled and unable to work IV All programs CO PEAK CBO Application User Manual Draft 5 12 2010 Page 27 Populating the People in the Household The next section within PEAK is to populate the household Again providing as much information as possible will allow eligibility technicians to make determinations more quickly The PEAK system will ask you complete information on the primary person in the household In our case Rose Bush s personal information needs to be completed further If a person is not applying for benefits then there is no need to complete the Citizenship or Ethnicity questions for that individual NOTE PEAK defines a household as everyone who lives in the home If you or the applicant you are assisting is uncertain whether to count a person as a household member PEAK advises think about whether or not the client is rel
47. e s care for example day care for your children how much you pay and who provides the care Information about your assets e If you re applying for Food Assistance we ll ask about the total amount of money you have at home and in your checking accounts and savings accounts Keep in mind that if you don t have a way to get the information we ve asked for an eligibility site worker may be able to help you get it Close Window Colorado gov Colorado Dept of Human Services Colorado Dept of Health 3 CO PEAK CBO Application User Manual Draft 5 12 2010 Page 17 We want to be able to track the number of applications that community based organizations assist with This page is important for you to fill out so that this data can be collected COLORADO Program Eligibility and Application Kit Colorado gov Colorado Dept of Human Services Colorado Dept of Health Care Policy and F Start Using PEAK Before you get started we d like to know more about how you re using PEAK PEAK on your own you can skip the last question and click the Next button application People Application Location Liquid Assets i From where are you applying lt click here to choose gt Applying on Your Behalf Other Assets If someone is using PEAK to apply on your behalf please click the button to tell us who is applying Job Income A person at an eligibility site that helps people apply for benefits Someone I have asked to be
48. eos Maps News Shopping Gmail more v Google colorado PEAK 9 Everything E News vi More Any time Latest v More search tools Tip Save time by hitting the retum key instead of clicking on search Colorado gov Colorado PEAK Program Eligibility and Application Kit The Colorado PEAK is a Web based portal designed to provide citizens and community partners with a modem and easily accessible tool to apply for public www colorado gavbenefits Cached Similar 14ers com Home of Colorado s Fourteeners and High Peaks Colorado Fourteeners Thirteeners Routes Trip Reports and more The largest collection of 14er and 13er photos on the Web Colorado 14ers 14er Routes Grouped by Difficulty Trip Reports www 14ers cani Cached Similar Pikes Peak Country Attractions Colorado Activities Official website of Pikes Peak Country Attractions Association See Pikes Peak and over 50 area attractions with the entire family veww_pikes peak coni Cached Samilar Pikes Peak Cam tm The video camera for the Pikes Peak Cam World Wide Web Page is mounted on the roof above the Pikes Peak Cam LLC offices in Colorado Springs Colorado PikesPeakCam Gallery About Pike s Peak Best Viewing Times www pikespeakcam com Cached Similar COLORADO PEAK Program Eligibility and Application Kit We re doing some werk on the Colorado PEAK website This means that you wont be able to use it right now But this kind
49. er and the type of policy Then click the Add button Name click here to choose z Add Selling or Giving Away Assets Please check the box for anyone who has sold traded or given away an asset in the last five years You should only check the box if the asset was sold traded or given away V No one r rh ff Wysteria Forsythia CO PEAK CBO Application User Manual Draft 5 12 2010 Page 42 Completing Job Income Information Indicate where the household receives its income PEAK will ask for details on each form of income indicated in the application COLORADO Program Eligibility and Application Kit Colorado gov Colorado Dept of Human Services Colorado Dept of Health Care Policy and Financing Accessibility kman amp i gag Prlints soona 57 Complete Start Job Income Information hex please tell us about the people in your home who have jobs or are self employed People a Current or Recent Job Please check the box for anyone who has a job right now or has had a job in the last 3 months Liquid Assets Don t check this box if the person is on strike from the job right now if they are paid only with goods or services instead of money or if they are self employed We ll ask about those next Other Assets No one T Job Income Other Income L J Housing Bilis Left or Lost a Job lease check the box for anyone who left or lost a job within t
50. ernet Explorer G O piseach al com aosearch s t comssarchs08a cokradot PEAK File Edt view Favortes Tool Help de e B colorado PEAK AOL Search Resuks Aol Search EEJ maoe Videos Maps News Shopping mor colorado PEAK Sear Google potter colorado PLAK Yahoo Search Results Windows Internet Explorer a te es aaa ea ee z Also Try peak program colorado spanish peaks west spanish peak colorado File Edt View Favorkes Tools Hep Be Be etcaerado PEAK Yahoo Search Resuts Peaks Rewards Sign Up amp Redeem Peaks Points at Five Ski Resorts Ofcial Site Guest Signi Hep WWW snow com Web images Video Local Shopping News More YaHoo colorado PEAK Colorado Mountain Express ground transportation from Denver Airport Book Online Now www ncecme com BW gt Search Pad Also try colorado peak to peak highway colorado peak pass More Single Hikers in Colorado somchscan on Colorado gov Colorado PEAK Program Eligibility and View Photo Profiles Local Singles into Hiking Join Now for Free The Colorado PEAK is a Web based portal designed to provide citizens and community www Finess Singles com partners with a modern and easily accessible tool to apply for public senna Hor www colorado gov benefts Cached More Offers colorado PEAK colorado car hire cheap colorado hotels colorado hotel colora a City of Colorado Springs Pikes Peak America s Mountain Homepage A Show
51. erstand my Rights amp Responsibilities in the box above e I understand the penalties for giving false information or breaking the rules e I understand that the eligibility site may contact other persons or organizations to obtain needed proof of my eligibility and level of benefits I understand that failure to report or verify any listed expenses will be seen as a statement by me that I do not want to receive a deduction for the unreported or unverified expenses I understand I can be punished by law if I do not tell the complete truth I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature By checking this box and typing my name below I am electronically signing my application First Name Middle Initial Last Name Rose Bush Qe Colorado gov Colorado Dept of Human Services Colorado Dept of Health Care Policy and Financi Accessibility NOTE The client must submit sign and submit their own application CO PEAK CBO Application User Manual Draft 5 12 2010 Page 61 The Initiated Application Submitting an application online is just the first step in ensuring that a client receives the benefits to which they may be eligible They must provide the eligibility site with the necessary documentation that supports their application Applications are sent to two locations e Family and children s medical only applications are sent to the Eligibil
52. es 45 days Home Community Based Service CO Works note Benefits cannot be processed until an orientation at the Workforce Center has been completed Long Term Care note Disability applications may take longer to process CO PEAK CBO Application User Manual Draft 5 12 2010 Page 67
53. es home care No one Wysteria Forsythia CO PEAK CBO Application User Manual Draft 5 12 2010 Page 53 Review of Other Bills Once the Other Bills information is completed you will be asked to review the information If it is correct use the Next button to finish initiating the application Change any incorrect information by using the links on this screen COLORADO Program Eligibility and Application Kit Colorado gov Colorado Dept of Human Services Colorado Dept of Health Care Policy and Financing Accessibility 63 Complete Liquid Assets Other Assets P Job Income Finish Q Submit Other Bills Summary Here is a summary of what you ve told us If you would like to change your answers to any of the fields in this section whether they are shown on this summary screen or not or finish a section click on Change or Add If you would like to remove something click on Erase Child or Adult Care Bills Who Pays For Who Provider Bill Change or Erase You ve told us that no one in your home pays for dependent care Add a Child or Adult Care Bill To add a child or adult care bill please choose the person who pays for the care and click the Add button Name lt click here to choose Review Your Answers Child Support Obligations Please check the box for anyone who makes child support payments to someone living in another household V No one
54. f Lilac Wysteria Forsythia Q Submit Health Insurance Please check the box for anyone who has lost health insurance coverage within the last 3 00000 months I No one Rose Lilac Wysteria Forsythia Previous SSI Benefits Please check the box for anyone who used to get Supplemental Security Income SSI but is no longer getting this benefit 7 a Lilac Wysteria Forsythia IV No one SSI Letter Please check the box for anyone who has received a Supplemental Security Income SSI approval letter even if you haven t actually received a payment 7 a Lilac Wysteria Forsythia MV No one SSI 1619 a or b Please check the box for anyone who is getting SSI 1619 4 or b benefits This program helps disabled people keep their health care coverage if they start working and are no longer able to get cash payments from SSI r ch Lilac Wysteria Forsythia vce saves ent nox CY V No one CO PEAK CBO Application User Manual Draft 5 12 2010 Page 55 Answer the questions about the client s education status COLORADO Program Eligibility and Application Kit Colorado gov Colorado Dept of Human Services Colorado Dept of Health Care Policy and Financing Accessibility 88 Complete O Q i Liquid Assets Other Assets Job Income Other Income Housing Bills Other Bills Submit 00000000 CO PEAK CBO Applicat
55. g to the people in your home By assets we mean things like cash you are saving at home l 300 00 checking and savings accounts Other Bilis m Housing Expenses Finish By housing expenses we mean rent or mortgage and utility bills For these bills please tell us the amount you are supposed to pay this calendar month even if you haven t been able to pay it but don t count unpaid bills from other months Submit sire How much will the people in your home pay for housing this month l 500 00 ia a i ee a ee A E Migrant or Seasonal Farm Worker Is anyone in your home a migrant or seasonal farm worker C Yes No If yes did his or her job recently end Yes No If yes will he or she get more than 25 from a new job or other source in Nee Se WS the next 10 days CO PEAK CBO Application User Manual Draft 5 12 2010 Page 24 Using the Help Function Colorado PEAK has a built in Help function that allows people to access explanations and definitions of terms being used on a particular page When someone clicks o the Help button the information will appear in a separate window ibility cation Kit florado go Colorado Dept of Human Services Colorado Dept of Health Care Policy and Financing Accessibilit er Benefits this page we re asking you to tell us about benefits that the people in your home may get edicare Part Aor B o answer this question check the box for anyone who gets or is entitled t
56. has a burial policy or any money set aside to be used for burial cremation or other funeral expenses V No one C E i E i C i Wysteria Forsythia Life Insurance Please check the box for anyone who has a life insurance policy V No one r r Wysteria Forsythia Selling or Giving Away Assets Please check the box for anyone who has sold traded or given away an asset in the last five years You should only check the box if the asset was sold traded or given away V No one r i Rose Lilac Wysteria Forsythia CO PEAK CBO Application User Manual Draft 5 12 2010 Page 40 If any other assets are owned PEAK will ask for further details on what is owned and the value of those assets COLORADO Program Eligibility and Application Kit ayes pa othe Ste i S tiae Colorado gov Colorado Dept of Human Services Colorado Dept of Health Care Policy and Financing Accessibility 39 Complete Liquid Assets Other Amen Job Income Other income Housing Bills Ar Bilts Finish Submit 2 amp O Q Q CO PEAK CBO Application User Manual Vehicles Next please check all boxes that apply to tell us which types of vehicles each person is buying has registered or owns Keep in mind that if an asset has more than one ow only need to tell us about that asset once Rose s Vehicles Truck SuY Recreational Vehicle W Car l Ngne
57. he last 60 days Other Bills V No one Finish a Rose Submit xor m On Strike Please check the box for anyone who has a job but is on strike or lockout V No one Rose In Kind Income Please check the box for anyone who provides a service in exchange for items such as food or rent For example someone who gets free housing in exchange for work V No one r Self Employment Please check the box for anyone who is self employed right now or has been self employed in the last 3 months V No one Colorado gov Colorado Dept of Human Services Colorado Dept of Health Care Policy and Financing Accessibility CO PEAK CBO Application User Manual Draft 5 12 2010 Page 43 COLORADO Program Eligibility and Application Kit Colorado gov Colorado Dept of Human Services Colorado Dept of Health Care Policy and Financing Accessibility Cima Print L Hele 59 Complete Start More About Rose s Job You ve told us that Rose has a job or has had a job in the last 3 months Please answer the questions below to tell us more about this job Employer Name of Employer Bark and Leaf Liquid Assets Address 0987 vibernum Lane oe Address Line 2 r Assets ha sai City State Zip Code Boulder Colorado z s0302 Job income Employer Phone 5 S 01 12 2007 When did Rose start this job Other income ee Job En
58. he website you will be on the Welcome page Simply move your cursor over the Enter button on the right side of the page and click to enter the PEAK tool CO PEAK CBO Application User Manual Draft 5 12 2010 Page 9 Colorado the otticia state web Portal Ey COLORADO i Program Eligibility and Application Kit About CBMS Services and Programs CBMS Roadmap News Contact Us Welcome B See How it Works iva Register to VOTE Allowing potential and existing clients the ability to check for eligibility and apply for benefits is a priority for the CBMS team and the Governor s Office of Information Technology COLORADO We are delighted to announce the new Program Eligibility and Application Kit PEAK PEAK Phase 1 coming this October will allow people in Colorado to screen or check if they may be eligible for benefits an and also check the status of their benefits Program Eligibility M and Application Kiz wir Michael Locatis Colorado State ClO Q Hours of Operation p idioma Espa ol es disponible para el sistema PEAK PEAK Overview In addition to growing client enrollment rates in the Colorado Benefits Management System CBMS programs Colorado is experiencing more widespread use of e communication and Web based interactions as well as a demand for increased client and community outreach capabilities from its public service agencies In order to meet these diverse needs head on the State of Colorado has beg
59. indness o Colorado Supplement to Aid to the Needy Disabled Aid to the Blind Supplemental Security Income providing state supplement payment to people who receive partial benefits from the federal Supplemental Security Income SSI program o Old Age Pension OAP providing financial assistance to low income individuals age 60 and over o Home Care Allowance HCA providing financial assistance to elderly and disabled individuals for services paid directly to a home care provider of their choice who assists the client with their activities of daily living such as bathing dressing transfers money management and appointment management o Adult Foster Care AFC providing financial assistance up to the current grant standard to pay for residential care to people who are unable to perform some activities of daily living and who need 24 hour supervision in a non medical residential facility o Burial Assistance providing financial assistance to help pay for funeral burial and or cremation costs for recipients of Aid to the Needy and Disabled Aid to the Blind Old Age Pension and Medicaid whose estates are insufficient to pay the total costs Medical Assistance Family Medicaid Family Medicaid is a public health insurance program for Colorado children 18 years of age and younger and for parents with dependent children Child Heath Plan Plus CHP CHP is low cost public health insurance for Colorado s uninsured chi
60. ing application If they have not yet initiated an application they will need to create an account To do this 1 Select the Create an account button and press the Next button in the bottom right of the screen COLORADO Program Eligibility and Application Kit Colorado gov Colorado Dept of Human Services Colorado Dept of Health Care Policy and Financing Accessibility cle Y pma Print g Holes Create An Account Before you get started on your application it s a good idea to create a secure account This should take just a few minutes If you create an account you can save your application and come back to it later We will also save the information as you go along If anything happens while you are working on your application you won t lose all of the work that you did Keep in mind that this is a secure website run by the State of Colorado Your information will be kept private and secure Please click one of the buttons to tell us what you would like to do Then click the Next button at the bottom of the page Create an account so you can save your application and come back to work on it later Log in using your existing account If you have an account and yoy don t log in now you will not be able to come back to your application later Colorado gov Colorado Dept of Human Servi Mlorado Dept of Health Care Policy and Financing Accessibil NOTE If an account is already set up in PEAK
61. ing on behalf of a child or are Cinar Astala pregnant check this box Otherwise click on the following link for more information about ther Assets other public medical assistance programs Department of Health Care Policy and Financing Some medical assistance programs can help with paying medical bills from the past three months Job Income If you want your benefits to start in a month that has already passed please check the box for that month Dther Income safBoninie January February March Cash Assistance ousing Bills Some families and individuals can get cash help e Low income families with at least one dependent child and home egnant woman in the OR e Low income persons age 60 or older Persons receiving SSI Persons disabled and unable to work TX All programs CO PEAK CBO Application User Manual Draft 5 12 2010 Page 20 Help the applicant complete as much information as possible The more complete the application is the easier it will be for the county Eligibility Technicians to determine whether the client exists in CBMS and what benefits the client may be eligible to receive COLORADO Program Eligibility and Application Kit Colorado gov Colorado Dept of Human Services Colorado Dept of Health Care Policy and Financing Accessibility Complete O Start Getting Started Let s get started on the application First please give us some basic informa
62. intenance Organization HMO for the child or children applying Please click here for additional information on HMO choices Please select an HMO from the list Kaiser Permanente Y If your children qualify for Medicaid Health Cole o will contact you to enroll in an HMO CO PEAK CBO Application User Manual Draft 5 12 2010 Page 60 Signing and Submitting the Application To sign the application the applicant should read the signature statement check the box and then enter their own name in the fields provided Electronic Signature If you have a legal guardian he or she should sign below If you have a power of attorney or an authorized representative either you or that person may sign this application If anyone else is helping you fill out the application you should sign the application yourself I have agreed to submit this application for myself and or my family By signing this application electronically I certify that I have reviewed this application that I understand and agree to the Rights Responsibilities and Penalties and that under penalty of perjury I certify the information I have given is true including the information concerning citizenship and alien status I have received information on how to apply what information is available and what I may need to give the eligibility site to help me with getting benefits e I understand the questions and statements on this application e I have read and und
63. ion User Manual School Enrollment Next we have a few questions about whether Rose is in school School Attendance Is Rose going to school now C Yes No If Rose is not going to school now does Rose plan to go to school within C Yes No the next 2 months School Enrollment Details Please click the button to tell us whether Rose has graduated from high school Earned high school equivalency or general equivalency diploma GED Graduated Has Not Graduated Please click the button to tell us how much time Rose is in school right now E Full time E Less than half time E Half time G Not in school oka whee of school Rose lt click here to choose gt If Rose is age 18 or older what is Rose s TO expected graduation date More School Information What is the name of the school which Rose a attends If you chose College University or Vocational School for the type of school Rose is in please check the box below for anything that applies to Rose Rose is caring for a child under 6 years old a Rose is caring for a child who is 6 to 12 years old and adequate daycare is not available for the child l Rose is caring for a child who is 6 to 12 years old and the child is enrolled in daycare Rose is in a federal or state funded work study program Draft 5 12 2010 Page 56 Review of the Final Questions 3 Start Final Summary biiadhna Here is a summary of what you ve told us
64. is a summary of what you ve told us If you would like to change your answers to any of the fields in this section whether they are shown on this summary screen or er not or finish a section click on Change or Add Review Your Answers Basic Information Summary Liquid Assets Address County 123 Sycamore Lane 4 Other Assets Boulder CO 80305 Boulder Job Income Review Your Answers Help From Others Representative Type Change or Erase Other Income You ve told us that you do not have an Authorized Representative or Power of Attorney Housing Bilis Add a Representative To add a representative please choose the type of representative and click the Add button lt click here to choose gt Wei OS ll Other Bills Type eview Your Answers Program Selection re are your answers to the other questions in this section Please take a look and make ure your answers are correct If they aren t correct you can check or uncheck the boxes to change your answers Please click the box for each benefit you would like to apply for T Food Assistance Food Assistance benefits come on a plastic card called Colorado Quest Cards which you can use to buy food at most food stores V Family and Children s Medical Assistance If you are looking for medical assistance for your family applying on behalf of a child or are pregnant check this box Otherwise click on the following link for mor
65. ity Assistance Site e All other applications cash assistance only nutrition assistance only combined applications will be sent to the nearest county office determined by zip code To find out the eligibility site that the application was sent to in order to follow up with documentation a client may use the links provided Thank You Thank you Your online application has been sent to a local eligibility site office If you have questions about the status of your online application please contact your local eligibility site If you give your online tracking number it can help you get answers more quickly Here is how you can find your local office For applications that are only for Family and Children s Medical Assistance click here For all other applications click here If you haven t heard back about an online app before submitting another online application ve submitted please be sure to c your local eligibility site These links connect to a pdf file containing the contact information for all eligibility sites in the state of Colorado Offices are listed alphabetically by county CHP Eligibility and Enrollment Contacts and COUNTY Eligibility Site Locations and Colorado PEAK Contacts CHP Contacts CHP Eligibility and Enrollment Vendor 518 17 St Suite 400 Denver CO 80202 Monday Friday 8 00 a m to 5 00 p m CHP Customer Service 800 359 1991 Monday Friday 8 00 a m to 6 00 p
66. job or self employment Other Income To add a type of other income please choose the person and the type of income then click the Add button Name Type lt click here to choose lt click here to choose gt Nie Ad qd Review Your Answers Other Questions Here are your answers to the other questions in this section Please take a look and make sure your answers are correct If they aren t correct you can check or uncheck the boxes to change your answers m Grants Loans or Scholarships Please check the box for anyone who is getting grants loans or scholarships for education or training V No one r Lilac Wysteria Forsythia m Review Your Answers Room and Meals Please check the box for anyone who makes money by providing a room and or meals to someone who is living in your home r rh orf Wysteria Forsythia Draft 5 12 2010 Page 47 Completing Housing Bills Information When completing the Housing Bills information it is important to capture all of the expenses that a client may be spending on shelter Colorado PEAK will ask for a breakdown of these costs over a series of screens Housing costs include the costs of any utilities that a client may be required pay PEAK will ask about these costs on separate screens COLORADO Program Eligibility and Application Kit Colorado gov Colorado Dept of Human Services Colorado Dept of Health Care Policy and Fin
67. king two secret questions that you can use if you ever need to recover your password Click on each box to choose a question that only you know the answer to Then fill in your answer It s a good idea to write down the answer you give since you will need to type it in exactly the same way if you lose your password Secret Question 1 hades U Answer to Secret Question 1 e eel Secret Question 2 k Answer to Secret Question 2 A 4 Colorado gov Colorado Dept of Human Services Colorado Dept are Policy and Financing Accessibility 3 Select the Create Account button CO PEAK CBO Application User Manual Draft 5 12 2010 Page 14 If the information you completed is accepted you will receive the following message COLORADO Program Eligibility and Application Kit Colorado gov Colorado Dept of Human Services Colorado Dept of Health Care Policy and Financing Accessibility Congratulations You have created an account Next Step To start working on your application you will need to log in using your new user name and password Click here to log in Colorado gov Colorado Dept of Human Services Colorado Dept of Health Care Policy and Financing A sibility You can then complete the login information and select the Log in button to begin an online application COLORADO Program Eligibility and Application Kit Colorado gov Colorado Dept of Human Services Colorado Dept of Health Car
68. ldren and pregnant women who earn too much to qualify for Medicaid but cannot afford private insurance Food Assistance Supplemental Nutrition Assistance Program SNAP SNAP is a program designed to assist low income people and families with the cost of purchasing food they need for good health CO PEAK CBO Application User Manual Draft 5 12 2010 Page 6 Session Flow Chart 1 Introduction 2 Login 3 Application 4 Conclusion CO PEAK CBO Application User Manual Draft 5 12 2010 Page 7 Getting Started Finding PEAK To access the PEAK website simply follow this link www colorado gov PEAK Alternatively you can use most major internet search engines and type in the words Colorado PEAK to find the link gt Google Windows Internet Explorer go Ni pt thre goodecom File Edt View Favortes Took Help Bem Web images Videos Maps News Shopping Gmail more v colorado PEAK colorado peaks colorado peak benefits colorado peaks dana wilson colorado peaks map colorado peaks pass colorado peak names colorado peak medicaid colorado peak elevations colorado peaks band colorado peaks card Google Search Google I m Feeling Lucky colorado PEAK Google Search Windows Internet Explorer Ge S itp tfemww google com search hleertisourceshpeqacobrado FEAKsbInG Googe SearchtaqaFtisq ag RarqieBoq tigs_sfat Took Help Web Images Vid
69. leting OWA BINS ccecce A oiii iiia cavecincuecessanuciiatsuciweatacinevisd n aaa a eaea aaiae 53 Review obher Bills 5B oe soesoesoecsecoeccescecsecsesoesoescesecsocceccccocesecseccecccssecseccccossoesocscescesees 54 Completing Final Questions s essesssssssoosoossossoesseesseeoseoseosecoccossosesossoeesseeseeoeecossossoossossoesseesseeseeseecessessese 55 Review of Finan hesMEpS seeecescscsesccsesscnccscescessencscsscsecsssecsescocoessessecsecoessessecsecsesoeseeseeseesee 57 Initiating the Application WEF seesceesesseessessosssesaseecesoceccesossoessossonssssssssesscssccesosssessossonssssssssessoseoosso 58 Client Rights and Responsibilities csssscsscescescesceeceecesceeccecceccescsssscsscesceeceecescesseescecseesees 58 Waiving the In Person Interview essessesseessecsecseecsecsecossosscossossoesseesoseoeeosecosssoesoesseeseeeseeseeosee 59 Selecting the HMO serdeni eiea E a 60 Signing and Submitting the Application sssessoeseesseeseeeseeseecsecsecossoossseeseesseeoseoossossoossoesoseseese 61 Printinge an ADDICatON ecann a a Ea Reati 66 Next Steps Completing the Application Process cssccsccsccecceceeccscceccesssssecsscscsscescessencescesceescecscasseessess 67 CO PEAK CBO Application User Manual Draft 5 12 2010 Page 2 Introduction Welcome to Colorado PEAK Colorado PEAK Program Eligibility and Application Kit is an exciting new website designed to ensure that every eligible
70. my authorized representative By authorized representative we mean someone who can apply on behalf of another person My legal guardian Other Income m Someone who has power of attorney for me Other O O O Housing Billy Other Human Services Colorado Dept of Health CO PEAK CBO Application User Manual Draft 5 12 2010 Page 18 If the Save amp Exit button is selected applicants will be asked to choose whether to save or submit that application Select the Save this application option to be able to return to the application later Selecting the Submit this application button will take applicants through a few steps before the application is submitted as outlined on page 61 of this manual COLORADO Program Eligibility and Application Kit Colorado gov Colorado Dept of Human Services Colorado Dept of Health Care Policy and Financing Accessibility h Print k e Help Save and Exit Ready to leave PEAK Please click one of the buttons to tell us what you would like to do Then click the Next button at the bottom of the page Save this application You can use your user name and password to log back in to finish and or submit your application Your application will be saved for up to 30 days after you last saved Submit this application You will not be able to use PEAK to change your answers or add more information to your application Colorado gov Colorado Dept
71. n updates that do not require So www colorado gowbenefits 800 832 6774 Call Today Mechanical industrial see through plastic Cut to size and custom fab WWW piaste 3uppiy com Peaks Rewards Sign Up amp Redeem Peaks Points at Five Ski Resorts Official Site a WW Snow CC PEEK Powder All Varieties Resins Milled to 10 100p Avg 3D Prototyping Medical Aerospace VW jeipul comihquajetic nim Single Hikers in Colorado View Phote Profiles Local Singles into Hiking Join Now for Free www Fitness Singies com Colorado Peaks at Amazon Millions of titles new amp used Qualified orders over 25 ship tree Amazon com books 14ers com Home of Colorado s Fourteeners and High Peaks By EatinHardtack Date Climbed 03 22 2010 Peakis Capitol Reef NP Since moving to Colorado 4 years ago I ve always been intrigued by our newghbonng state of Utah s vast desert playground There s only one thing I ve still yet t go unt Bo www idats com 14ers com Colorado 14ers To be ranked a peak must nse at least 300 feet above the saddle that connects it to the nearest 14er peak if another exists nearby This guideline has been in use in Colorado for some time So wry t4ers com photos pholos 14ers 1 php PEAK Parent xne Lastly you can find the PEAK website by linking from any number of state agency websites including http www cdhs state co us http www colorado gov hcpf http www colorado gov oit Once you have linked to t
72. o get Medicare Part or Part B Medicare we mean the federal health insurance program for elderly 65 or older blind or disabled people Part is also known as Hospital coverage while Part B is also known as Medical coverage Keep in mind that Medicare is not the same as Medicaid Most people who have Medicare have a Red White and Blue card Health Care Coverage To answer this question check the box for anyone who has health care coverage now or has had health care coverage in the last 8 months By health care coverage we mean any insurance policy that pays for a doctor s services in an in patient or outpatient etting If your insurance is limited to only to accidents disability vision care long term care or dental services you should not eck the box ious SSI benefits wer this question check the box for anyone who used to get Supplemental Security Income payments SSI but isn t RSI any more Keep in mind that SSI is a monthly payment for people with very low incomes who are at least 65 o d SSI is not a retirement benefit and it is not the same as Social Security a person would stop getting SSI only if his or her income went up s a result he or she is no longey still getting SSI you should not check the box for that person he box for anyone who has received an approval letter from the So ental Security Income payments SSI People who are get hyments yet but have the approval letter should also ly paymen
73. of work usually doesnt take very httos peak state co us Cached COLORADO PEAK Program Eligibility and Application Kit PEAK is a quick and easy way for people in Colorado to get answers to questions on health and nutrition programs Please click on a picture below to choose https peak state co us selfsensce Cached City of Colorado Springs Pikes Peak America s Mountain Homepage City of Colorado Springs The Official web site for the City of Colorado Springs Colorado The city sits at the foot of Pikes Peak Amenca s mountain colorado PEAK Bing Windows Internet Explorer 6 E Bitttp itvbing com searchitq colorador PEAKForm QeLHBas nask Bsc 1 1 3hadk strict File Edt View Favortes Tools Help We Be E oora PEAK Bing News Maps More colorado PEAK RESULT 10 of 45 results Advanced Safe Search Strict Colorado gov Colorado PEAK Program Eligibility and The Colorado PEAK is a Web based portal designed to provide citizens and community partners with a modem and easily accessible tool to apply for public assistance benefits www colorado gowbenefits Ca age Vail Peaks Card Pikes Peak Wikipedia the free encyclopedia Pikes Peak originally Pike s Peak see below is a mountain in the Front Range of the Rocky Mountains 10 mies 16 km west of Colorado Springs Colorado in El Paso County Geography and geology Name Discovery History en wikipedia org wiki Pikes_ Peak Colora
74. olicies C Social Security Number Social Security numbers or proof of application for everyone requesting benefits If you state on the application that you have a Social Security Number you will need to provide proof aw Proof of Citizenship or Alien Status Proof of status in this country such as Visa Legal Permanent Resident Card Passport or Employment Authorization Card for everyone you are applying for wi Proof of Income Proof of current wages or income for your household such as pay stubs award letter employer letter Social Security child support Proof of Expenses Proof of expenses such as day care rent mortgage utilities child support or medical costs CO PEAK CBO Application User Manual Draft 5 12 2010 Page 64 The Tracking Number It is important that the tracking number of the application that has been submitted be retained This number can be referred to when documents are shown to the eligibility site Encourage your clients to keep this number in a safe place until their benefits are determined Keep track of your application 7 Your tracking number for this application is 1000475611 Be sure to write this number down or print this page for your records By law you will get an answer about your application within certain time limits e For Food Assistance Households who qualify may get Food Assistance as soon as 7 days from the received date of the application if they e have
75. ou more about applying for benefits through PEAK Before you get started on your application it s a good idea to gather the information listed below Having this information will help you answer the questions in the application The more complete your application is when you submit it the faster an eligibility site worker will be able to process it Full names dates of birth and Social Security Numbers SSN for the people who are applying for benefits If someone in your home is pregnant the due date and number of babies for that pregnancy If someone is working pay check stubs for that person s job s We ll be asking how much each person makes at their job how often they get paid and how many hours they work Benefit check stubs or award letters for types of income like Social Security Supplemental Security Income SSI or Child Support We ll ask when these types of benefits started how much they get paid and how often they get paid If someone is self employed last year s tax return for their self employment if they filed taxes for the business Otherwise try to gather information about their income and expenses for the business Information about the expenses you pay For example e How much you pay each month for housing things like rent lot rent mortgage property taxes or homeowner s insurance e Which utilities you pay each month things like electricity gas phone water and trash removal e If you pay for someon
76. pplication Kit Colorado gov Colorado Dept of Human Services Colorado Dept of Health Care Policy and Financing Accessibility manans anenams aioasesss 74 Complete Start Natural Gas Payment You ve told us that your household pays for Natural Gas Please answer the questions below to tell us more about this payment If you don t pay for this each month please estimate what it costs on a monthly basis How much does the Natural Gas cost each month 25 Liquid Assets What is the name of the company provider or landlord you excel s C lt C2C 7C pay for this utility If this bill is not in a household member s name what is the C Other Assets customer s name on the account J P Job income CO PEAK CBO Application User Manual Draft 5 12 2010 Page 51 Review of Housing Bills Confirm that all of the housing expenses have been captured accurately and select the Next button to continue with the application COLORADO Program Eligibility and Application Kit Colorado gov Colorado Dept of Human Services Colorado Dept of Health Care Policy and Financing Accessibility we f E3 we Print e Hele a 76 Complete Start Housing and Utility Bills Summary Here is 4 summary of what you ve told us If you would like to change your answers to any of the fields in this section whether they are shown on this summary screen or not or finish a section click on Change or Add
77. pt of Human Services Colorado Dept of Health Care Policy and Financing Accessibility CO PEAK CBO Application User Manual Draft 5 12 2010 Page 39 Completing Other Assets Defining Other Assets Other Assets are defined as any vehicles cars trucks motorcycles etc real estate houses condominiums mobile homes land farms and mineral rights burial funds or life insurance policies that are owned by members of the household Other Assets Next please tell us about the people in your home who have other kinds of assets If someone owns an asset with another person please check the box for just one owner Later we ll ask about who else owns the asset Keep in mind that we re only asking about assets for some of the people in your home If someone isn t listed below we don t need to know about their assets Vehicles Please check the box for anyone who has a vehicle that you are buying have registered or own By vehicles we mean things like cars trucks motorcycles campers boats farm r equipment etc Job Income No one Other income v r n cf Rose Lilac Wysteria Forsythia i Housing Bilis v Real Estate Please check the box for anyone who owns real estate By real estate we mean things like houses condos mobile homes land farms mineral rights etc V No one O r i Wysteria Forsythia Burial Assets Please check the box for anyone who
78. s 7 er er Lilac Wysteria Forsythia I No one Grants Loans or Scholarships Please check the box for anyone who is getting grants loans or scholarships for education or training M No one Wysteria Forsythia Room and Meals Please check the box for anyone who makes money by providing 4 room and or meals to someone who is living in your home M No one c Lilac Wysteria CO PEAK CBO Application User Manual Draft 5 12 2010 Page 46 Review of Other Income Review the information provided in the Other Income section and make adjustments as necessary COLORADO Program Eligibility and Application Kit Colorado gov Colorado Dept of Human Services Colorado Dept of Health Care Policy and Financing Accessibility 67 Complete Start EY r Liquid Assets Other Assets d Job income Caner income Housing Bilis Other Bills Finish Submit CO PEAK CBO Application User Manual pang Print ke e Help 3 nies Other Income Summary Here is a summary of what you ve told us If you would like to change your answers to any of the fields in this section whether they are shown on this summary screen or not or finish a section click on Change or Add If you would like to remove something click on Erase Other income Type How Much Frequency Change or Erase You ve told us that no one in your home has income from a source other than a
79. s fourteeners other peaks and wildlife photos Ekes Peak Sam imi kes Peak C World Wide Web P h of www 14ers com 81k Cached e video camera for the Pikes Peak Cam World Wide Web Page is mounted on the ro above the Pikes Peak Cam LLC offices in Colorado Springs Colorado Castle Peak Colorado Wikipedia the free encyclopedia www pikespeakcam com Similar Castle Peak is a fourteener in the Elk Mountains in the US state of py praca lacks ply viateitin gps Daan agg COLORADO PEAK Program Eligibility and Application Kit County line and about 15 miles 24 km south of We re doing some work on the Colorado PEAK website This means that you wont be able to en wikipedia org wiki Castle_Peak Colorado 60k Cached use it right now But this kind of work usually doesn t take very colorado peak Ask com Search Windows Internet Explorer Ge v E btn iveew ask comiweb q colorado peakesoarch Bqsrc 080 Cai dr File Edit View Favortes Tools Heb r BeBe colorada peak Ask com X Bf colerado gov Colorado PEA J Web images News Deal Videos QSA sea More Colorado qov Colorado PEAK Program Eligibility and Application Kit The Colorado PEAK is a Web based portal designed to provide citizens and community partners with a modem and easily accessible tool to apply for public assistance benefits Instead the Colorado PEAK creates new opportunities for benefits screening application and chent informatio
80. s website works best with Internet Explorer version 5 5 or higher Click on the picture to see Click on the picture to Click on the picture to Click on the picture if you might be eligible to apply online for benefits check the status of your report a change to receive benefits benefits eligibility site To learn more about the types of assistance available please click on the following link s Food Assistance Family and Childyen s Medical Assistance Assistance Colorado gov Colorado Dept of Human Colorado Dept of Health Care Policy and Financing Accessibilit CO PEAK CBO Application User Manual Draft 5 12 2010 Page 11 By clicking on the appropriate icon you launch the function that you would like to complete With PEAK you have the following four choices AM I ELIGIBLE APPLY FOR BENEFITS CHECK MY BENEFITS REPORT MY CHANGES Click on the picture to check the status of your benefits Click on the picture to see Click on the pict if you might be eligible to apply online for b receive benefits Click on the picture to report 4 change to your eligibility site After selecting the Apply for Benefits icon the system will take you through a login process CO PEAK CBO Application User Manual Draft 5 12 2010 Page 12 Logging In Once the applicant has entered the online application form on the PEAK website they will be asked to create an account or login into an exist
81. s will process the case If there are still documents to submit then clients will need to review the checklist of items given either in person or by mail and submit their remainng documents The best way for applicants to submit documents is to bring them to the county office or Certified Application Assistance Site near where they live Copies of all other documents can also be submitted by fax or mail Some counties can accept scanned and e mailed documents Visit www colorado gov PEAK to find all of the contact information needed to submit NOTE Medical programs need to see originals of IDs and or Birth Certificates How will applicants know that their benefits are approved Applicants will receive a letter once benefits have been determined They may also receive a phone call from a technician however most counties will send a standard letter If clients would like to know how to get more information on their benefits they can sign on to one of the following e PEAK Website www colorado gov PEAK Check My Benefits unlimited access e EBT Website www coloquestcard com unlimited access e EBT Customer Service phone line 1 888 328 2656 limited to 10 calls per month How long will it take to process benefits Technicians will work as quickly as possible to complete application as soon as they receive all of the supporting documents The chart below explains how long it may take to process an application based on program rul
82. t describes your client s situation If there isn t a description that describes your client s relationship to the Head of Household select the Other category COLORADO Program Eligibility and Application Kit Colorado gov Colorado Dept of Human Services Colorado Dept of Health Care Policy and Financing Accessibility imam j pma Print og Hele J Oech A ee eee eee 16 Complete How You Are Related Please tell us how the people in your home are related to each other Rose s Relationship to Lilac Liquid Assets fis the Mother of f is the Mother of is the Niece of is the Sister of is the Step Daughter of is the Step Mother of is the Step Sister of ip tis the Great Grand Niece of is the ist Cousin Removed of is the Cousin of is the In Law of is the Great Great Aunt of Lilac Yes No Wysteria Rose ets Does Rose purchase anc Does Rose purchase and prepare meals with Wysteria Yes No ing Bilis Rose s Relationship to Forsythia Other Bilis Po lis the Mother of i Finish Rose Forsythia Does Rose purchase and prepare meals with Forsythia Yes No Submit CO PEAK CBO Application User Manual Draft 5 12 2010 Page 32 PEAK will ask you to define the relationships between the other members of the household next NOTE PEAK will ask if the other members of the household purchase and prepare me
83. t for people the same as Social 7 w KA ie a oe a aan mee the box for an r Medicaid co and Financing Accessibility o jee Print keenly ETN D ERETNA 1 7 Oe ee ete oe CO PEAK CBO Application User Manual Draft 5 12 2010 Page 25 Review of Start Information The Colorado PEAK system will continually ask you to verify the information entered for the client It will give you the option to correct information To do this you 1 Select the Change link on the right of the table containing the information to be corrected Or 2 Use the Back button on the bottom of the page to return to the screen with the information that needs to be corrected 12 Complete O Start Basic Information Summary Here is a summary of what you ve told us If you would like to change your answers to any of the fields in this section whether they are shown on this summary screen or not or finish a section click on Change or Add Biss sl Review Your Answers Basic information Summary Address County Liquid Assets 123 Sycamore Lane Other hace i Boulder CO 80305 inh In enamea CO PEAK CBO Application User Manual Draft 5 12 2010 Page 26 COLORADO Program Eligibility and Application Kit Colorado gov Colorado Dept of Human Services Colorado Dept of Health Care Policy and Financing Accessibility 12 Complete Start Basic Information Summary Here
84. te in the United States 1 Colorado Health Institute Retrieved on November 25 2009 from U S Census Bureaus 2007 American Community Survey Retrieved on December 13 2008 from hitp www census gov cgi bin saipe saipe cgi Colorado Children s Campaign 2010 Kids Count Annual Report ta http www denverpost com ci_14871634 source email CO PEAK CBO Application User Manual Draft 5 12 2010 Page 5 Human Services Programs Supported by PEAK The Colorado PEAK online application form allows Coloradans to apply for the following food medical and cash assistance benefits that will help them gain self sufficiency and thrive Cash Assistance Temporary Assistance for Needy Families TANF TANF known as Colorado Works in Colorado provides family stabilization services and helps eligible low income families find and retain employment Assistance and services provided may include child care housing cash payments transportation and counseling Adult Financial AF The Adult Financial program provides financial assistance to low income aged blind and disabled people who need help in meeting basic living costs o Aid to the Needy Disabled AND providing financial assistance to low income people over age 18 who have total disability lasting six months or longer that prevents them from working o Aid to the Blind AB providing financial assistance to low income people of any age who meet the Social Security definition of bl
85. the household receives any other income from sources that are not job related a ae en es Reet prin a COLORADO Program Eligibility and Application Kit Colorado gov Colorado Dept of Human Services Colorado Dept of Health Care Policy and Financing Accessibility i Print 5 Help 63 Complete O Start Money From Other Sources Next please tell us about the money that the people in your home get from sources other than a job or self employment If you re not sure about a source of income click on Help to read more about what we re looking for i Supplemental Security Income SSI Liquid Assets Please check the box for anyone who gets or will get Supplemental Security Income SSI Keep in mind that SSI is a monthly payment for people with low income who are disabled or over age 65 SSI is not a retirement benefit T z re n Lilac Wysteria Forsythia Other Assets I No one Job income Other Income Retirement Social Security Please check the box for anyone who gets or will get Retirement Social Security Keep in mind Social Security income is not the same thing as Supplemental Security Income SSI Housing Bills Other Bills I No one Finish i O m Submit Lilac Wysteria Forsythia 00000000 Please check the box for anyone who will get any type of income or payments from a source other than a job SSI or Social Security this month such as child support payment
86. this person live Homeless without Shelter Living Alone Residence Information Living with one other person Is this person a resident of Colorado Shale use nore than ong otsi Living with Parents Nursing Home Not in the Home Homeless living in Shelter Home with institutionalized Spouse Long Term Care Other Unknown Where does this person live Living with one other person Does this person plan to stay as a resident of Colorado Is this person a migrant worker CO PEAK CBO Application User Manual Draft 5 12 2010 Page 29 Populating Additional Household Members PEAK will ask you to complete the same fields for each additional member of the household NOTE Be sure to complete the Program Selection for each additional household member This will need to be done for each additional individual Start People In Your Home i i You have already told us about the following person d Liquid Assets Please tell us about the next person in your home Other Assets Personal Information First Name Middle Initial Last Name Jr Sr etc Job Income lilac Bush x Gender Male Female Other Income Date of Birth 08 22 1999 What is this person s marital status Single Never Married What language does this person prefer to use English x Housing Bills Other Bills Has this person ever used another name such as maiden name alias
87. tion about you People Information About You First Name Middle Initial Last Name Liquid Assets I Gender Male Female Other Assets Date of Birth C Ex mmfdd yyyy What is the primary language for your household lt click here to choose gt In what county do you live lt click here to choose gt Job Income Other Income Housing Bills Is anyone in the household age 18 or older interested in registering to vote Yes No Where You Live Other Bills 7 Please tell us where you live If you are homeless right now please check the I am homeless box If you are homeless but you have a mailing address please check the box and type your address in here Finish T I am homeless right now I I amin a nursing home Submit Street PO Box or Street Name Apt Mailing Address If you don t want us to send any letters about your benefits to the address you ve given above please give us the mailing address where we should send your letters instead If it s okay to send letters to the address listed above please leave this blank Street PO Box or Street Name Apt City State Zip Colorado Contact Information Please tell us how we can get in touch with you For the phone numbers please be sure to include area codes Primary Phone Message Phone gt Email Address CO PEAK CBO Applic
88. un work to implement revolutionary enhancements that will allow it to continue to improve the lives of its citizens On this opening page the client may also register to vote see a demonstration of how to use Colorado PEAK see press releases about PEAK and contact us with any questions you may have Colorado te official state web Portai O10 57 1310 Program Eligibility and Application Kit About CBMS Services and Programs CBMS Roadmap News Contact Us Welcome B See How it Works a Y Regi Yer to VOTE CO PEAK CBO Application User Manual Draft 5 12 2010 Page 10 After entering the Colorado PEAK webpage you will land on the PEAK Welcome page with four icons to choose from COLORADO Program Eligibility and Application Kit Colorado gov Colorado i 4 Care Policy and Financing Accessibility Welcome to PEAK PEAK is a quick and easy way for ople in Colorado to get answers to question on Food Assistance Cash Assistance and Family and Children s Medical Assis nce programs Please click on a picture below to choose the tool you would like to use If you need help with using a computer click here to read more about how to use this website Para ver este website en Espanol oprima aqui To avoid errors when using the application please do not use the Forward Back or Stop buttons on your browser Instead click on the pictures and links to move from page to page Please keep in mind that thi
89. very little or no money e have shelter costs that are more than the household monthly income e are in a migrant worker household Otherwise you will get an answer about your application within 30 days from the received date of your application e For Cash Assistance If you have a dependent child and apply for Cash Assistance you will get an answer about your application within 30 45 days of the received date of your application If you are over the age of 60 or have a disability you will get an answer about your application within 60 days of the received date of your application e For Family and Children s Medical Assistance You will get an answer about your application within 45 days of the received date of your application Completing the Optional Survey In an effort to get feedback on PEAK clients are encouraged to take the optional survey It is a quick survey that takes just minutes to complete and is accessed by the clicking on the Survey button on the application Optional Survey Click the Survey button to take a short survey about your online experience It should take just a few minutes to complete the survey CO PEAK CBO Application User Manual Draft 5 12 2010 Page 65 Printing an Application The PEAK online application can be printed out using the Print My Application button if the client wants a hard copy Also this option may be important for certain medical determination
90. y activity on this site for 15 minutes or longer you will be asked to log back in to access you ation Any information that has not been saved will be lost Please note as you move from one e Next button your information will be saved up to that point In this application w NI ask you questions about the people in your home your money and your bills To answer these questions it s a A d idea to have your pay stubs or benefit check stubs with you as well as the bills you pay each month for housing ilities and child care If you d like to see a list of the items you may want to gather before you start your application Slick here Once you finish answering these questions your application will be handled by an eligibility site near you Before you can get benefits the eligibility site may need to get proof of some of the answers you have given In some cases you will also need to talk with an eligibility site worker over the phone or in person Your local eligibility site will call you or send a letter about this You have the right to have another person apply for benefits for you This person is called your Authorized Representative or AR You ll have a chance to appoint an AR later in this application COLORADO Program Eligibility and Application Kit Colorado gov Colorado Dept of Human Services Colorado Dept of Health Care Policy and Financing 4 Apply For Benefits A Few Things You Should Know This page tells y
91. your client and have them complete the application with an Eligibility Technician To do this select the Set my application date and complete my application later with an eligibility site worker option at the bottom of the screen Colorado gov Colorado Dept of Human Services Colorado Dept of Health Care Policy and Financing Accessibility Keep Working or Set Application Date At this point you may set your application date Your application date is the Received Date which is the first business day after your application is received by your local eligibility site This is the date that your benefits will start if your application is approve Each program has a different time limit for reviewing applications If you are applying for e Food Assistance You will get an answer about your application within 30 days from the res of your application e Cash Assistance If you have a dependent child and apply for Cash Assistance you will get an an about your application within 30 45 days of the received date of your application ia you are over the age of 60 or have a disability you will get an answer about your Job Income i application within 60 days of the received date of your application j ara eae ih Adah aie AAA a a e Family and Children s Medical Assistance ro You will get an answer about your application within 45 days of the received date of Other income _ your application D T r T T E T T

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