American Legion Temporary Financial Form – Fill Out and Use This PDF

OTHER ASSISTANCE

In order to be considered for a Temporary Financial Assistance grant, all other forms of possible assistance must be applied for and exhausted. Failure to completely document this in the following section will result in delay or denial of the application.

Source	Date		Status			Amount approved or explanation of
	Applied					ineligibility
Post, Unit, or		฀ Approved	฀ Denied	฀ Pending	฀ Not Eligible
Squadron
Assistance for Needy		฀ Approved	฀ Denied	฀ Pending	฀ Not Eligible
Families
VA Disability		฀ Approved	฀ Denied	฀ Pending	฀ Not Eligible
Pension
Social Security		฀ Approved	฀ Denied	฀ Pending	฀ Not Eligible
Disability
Supplemental		฀ Approved	฀ Denied	฀ Pending	฀ Not Eligible
Security Income
Medicaid		฀ Approved	฀ Denied	฀ Pending	฀ Not Eligible
Public Assistance		฀ Approved	฀ Denied	฀ Pending	฀ Not Eligible
Unemployment		฀ Approved	฀ Denied	฀ Pending	฀ Not Eligible
Private Charities		฀ Approved	฀ Denied	฀ Pending	฀ Not Eligible
Food Stamps		฀ Approved	฀ Denied	฀ Pending	฀ Not Eligible
Women, Infants, &		฀ Approved	฀ Denied	฀ Pending	฀ Not Eligible
Children (WIC)
Other		฀ Approved	฀ Denied	฀ Pending	฀ Not Eligible

CREDITOR INFORMATION

Most approved checks will be two-party, made payable to the veteran or guardian and the creditor. Please ensure that creditor

information is accurate and the name is legible. Only listed creditors in this section will be considered for payment.

Mortgage or Landlord __________________________________________________ Phone __________________________

Street Address ________________________________________________________________________________________

City ____________________________________________________ State ________ Zip ___________________________

Utility Company/ Other _________________________________________________ Phone _________________________

Utility Company/ Other _________________________________________________ Phone _________________________

Utility Company/ Other _________________________________________________ Phone _________________________

Utility Company/ Other _________________________________________________ Phone _________________________

Attach current statements, bills, disconnection/eviction notices, and all other expenses to be considered.

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FINANCIAL INFORMATION

Include only recurring monthly gross income and expenses. Do not include one-time assistance or accumulative balances on past due

expenses. Gross income must include earnings of all persons in the household.

	Monthly Gross Income		Monthly Expenses
Earnings of Veteran/Guardian		$_______________	Shelter	$_______________
Earnings of other Parent		$_______________	Electricity	$_______________
Earnings of others		$_______________	Gas	$_______________
VA Pension		$_______________	Water/ sewage	$_______________
Social Security		$_______________	Food	$_______________
Child Support		$_______________	Automobile	$_______________
Other monthly income		$_______________	Clothing	$_______________
			Other	$_______________
			Specify _______________________
Total Gross Monthly Income		$_______________	Total Expenses $_______________

INVESTIGATOR’S REPORT

The investigation must include a detailed description the applicant’s situation, steps taken to improve the situation, and follow-up

plans of the Post and/or investigator. Incomplete investigation reports will result in delay or denial of the application.

___________________________________________________________________________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

Attach additional sheet(s) as needed.

SIGNATURES

Investigator

I certify that I conducted the above investigation and that the applicant has exhausted all other forms of known assistance.

Name & Title________________________________________________________ Phone __________________________

Street Address _______________________________________________________________________________________

Signature ___________________________________________________________ Date ___________________________

Applicant

I, the applicant, certify that the information contained in this application is true and current to the best of my knowledge. Signature ___________________________________________________________ Date ___________________________

Department Children & Youth Chairman or Authorized Department Official

I have thoroughly reviewed this application and recommend the following: ฀ Approval $ _____________________ ฀ Denial

Comments __________________________________________________________________________________________

___________________________________________________________________________________________________

Signature ___________________________________________________________ Date ___________________________

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TEMPORARY FINANCIAL ASSISTANCE (TFA) INSTRUCTIONS AND PROCEDURES

1.Prior to completing an investigation and application, determine if the minor child is eligible for TFA. The minor child must not be older than 17, or 20 if enrolled in high school or physically handicapped, and be the biological child of an eligible veteran or be in the legal custody of an eligible veteran. An eligible veteran has served honorably and at least one day of active duty during the eligibility period. Active duty must be Federal active duty (Title 10).

Eligible Periods

World War II December 7, 1941 – December 31, 1946

Korean War	June 25, 1950 – January 31, 1955
Vietnam War	February 28, 1961 – May 7, 1975

Lebanon & Grenada August 24, 1982 – July 31, 1984

Panama December 20, 1989 – January 31, 1990

Persian Gulf August 2, 1990 – Present

If the veteran does not have active service within these dates, the child will not be eligible. There are no exceptions.

2.Once you have determined that the minor child(ren) is eligible, make an appointment with the family at their residence to complete the application if possible. Secure all requested documentation and provide all requested information. Your report must include a detailed description of the family’s financial need, steps taken to alleviate the situation, and follow-up plans of the Post and/or Investigator.

3.TFA is strictly for the basic needs of minor children including shelter, utilities, food, clothing, and medical. Medical grants must be approved prior to treatment and must be accompanied by a physician’s statement and estimated costs.

TFA will not pay for: Cable, Consumer Debt, Internet Services, Insurance, Taxes, Transportation, Previous Debt, or any expense that does not contribute to the active basic needs of minor children.

4. The following documents must accompany the TFA application:

DD214, VA statement of service, military orders, or other official proof of active duty discharge type

Birth certificates of children

Marriage license

Custody documentation and legal name changes

All current statements, bills, leases, foreclosures, eviction notices, disconnection notices to be considered. Expenses not documented will not be considered.

5.Ensure all sections of the application are complete and the appropriate signatures are obtained. Incomplete applications may result in delays or denial.

6.TFA recipients may not reapply until 30 days from the issue date of the last check. All previous recipients require a new completed application to include current statements and expenses to be considered.

7.Applications must be sent to your Department Children & Youth Chairman or Headquarters for approval. All applications sent directly to National Headquarters will be returned to the appropriate Department without review or action.

Before sending a TFA application to the Department C&Y Chairman or Department Headquarters, did you:

฀Determine that the child or children are eligible for TFA?

฀Complete all sections of the application and attach all required documents?

฀Obtain all required signatures?

฀Conduct a complete investigation and ensure that all other forms of assistance have been exhausted?

฀Make a copy for your records in case of lost or destroyed applications?

All communication about submitted applications should be directed to the Department Children & Youth Chairman or

Department Headquarters. To protect the privacy of applicants, National Headquarters will not release any

information other than to the Department.

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