Nidaamka Warbixinta la Fududeeyay ee Gargaarka Cuntada iyo Daryeelka

Xanaanada Carruurta ee Dadka Shaqeeya

WAXAAD KA WADA JAWAABTAA SU’AALAHA OO IDIL. WAXAAD HUBISAA IN AAD SAXIIXDO OO AAD TAARIIKHDA KU QORTO XAGGA DAMBE.

Interim Change Report For Food Stamps (FS) and Employment Related Day Care (ERDC) Somali DHS 852 (04/02/09)Can use (4/09) version

Digniin: Ha soo celin foomkan inta ka horreysa kowda bisha kor ku taal. Dib ayaan foomka kugu soo celin doonaa haddi aad xilli hore soo dirto.

Program Branch Case Number Worker ID

Case Name

Waxaad soo celisaa inta u dhexeysa 1-da iyo 10-ka bisha:

SI UU GARGAARKA KUGU SOCDO WAXAAD FOOMKAN SOO CELISAA INTA AAN LA GAARIN 10-KA.

• Waainaadfoomkansoogudbisosiaadgargaarkauhesho. • Adigaiyodadkakulanoolayeeytahayinaadsu’aalahaugajawaabto___________________. • Waxaadsooraacisaawarqaddheeraadahhaddiiaadubaahatomeelbannaan. • WAXAAD SOO RAACISAA CADDEYN kusaabsanwarbixintaaadbixisay. • Haddiiaadubaahantahayinfoomkaanlagaacaawiyo,waxaadwacdaalambarkakorkuyaal.

Haddiiloobaahdo,kharashkataleefoonkawaadinagusoowareejinkartaa. Waxaa suuragal ah in gargaarkaagu uu dibu dhaco haddii: • Aad foomkan soo celiso wixii ka dambeeya 10-ka bisha, ama • Haddii aan la soo wada buuxin.

Sida Foomkaan Loo IsticmaaloFoomkanwaxaalagudoonayaainlaogaadohaddiiaadweliuqalantogargaarkacuntadaiyo/amadaryeelkaxanaanadacarruurta.Waxaadkawadajawaabtaasu’aalahaidinkuwadasaabsanadigaiyodadkakulanool.Waxaadsheegtaadakhligareerkaooidilsoogala.Waxaakamidnoqonkaradakhligashaqadaiyodakhligaaanshaqadakusaabsaneyneesoogalareerkaooidil.

Gargaarkaagu waa uu joogsanayaa haddii aadan soo buuxin ama celin foomkan inta ka horreysa dhammaadka bisha foomkan la doonayo.

StateofOregonDepartmentofHumanServicesChildren,AdultsandFamilies

FOOMKANI MA AHA ARJI CUSUB

QaybtaAdeegyadaDadweynaha(DepartmentofHumanServices:DHS)cidnamaaytakooridoonto.TanimacnaheeduwaainDHSaysaacididoontodhammaanintauqalanta.DHSqofnacaawinaadugumadiididoontoiyadooaysababugadhigaysoda’da,jinsiyadda,midabka,asalkaqaranimada,nooca,noocagalmada,diinta,siyaasaddalaaaminsanyahayamaitaal-darrida.HaddiiaadfilaysidinDHSaysababahanmidkoodakuugutakoortayashtakoayaadsoogudbinkaraysaa.

Siaadashtakousoogudbiso,waxaadqoraalusoodirtaaUSDA,Director,OfficeofCivilRights,Room326-W,WhittenBuilding,1400IndependenceAvenue,S.W.,WashingtonD.C.20250-9410amawaxaadwacdaa(202)720-5964(codkaiyoTDD).USDAwaahay’adiyoshaqaaleyecaddaaladkudhisan.

F Ay tahay in aan foomkan soo gudbiyo si aan gargaarka u helo. Waa in aan sugo illaa laga gaarayotaariikhdalasoocelinayoookutaalfoomkandushiisasiaanuxaqiijiyoinaangudbiyaywarbixintaooidil.

F In aan shaqaalaha ama qofka mas’uulka ah aan la xiriiri karohaddiiaanwaxsu’aaloahkaqabofoomkan.

F In aan ka diiwaangeliyo barnaamijka OFSETdadkaqoyskaygakatirsaneeqaatagargaarkaBarnaamijkaCuntada(FS)

F In jawaabta aan ku bixiyo foomkan ay saameyn ku yeelan doonto gargaarkayga. Macluumaadkaniwaxaykeenikaraaningargaarkaygauukordho,hoosudhacoamajoogsado.Waxaanhelidoonaaogeysiissharraxayasidajawaabahaaanfoomkankubixiyousaameyndoonaangargaarkaaanheloiyosidadhegeysimaxkamadloocodsado.

F Haddii aan qaato gargaarka daryeelka xanaanada,inaansoogudbiyowixiiwarbixinaheekusaabsanisbeddelkakuyimaadqofkacarruurtaxanaaneeyo,shaqola’aanamamarkawaalidkacarruurtaamailmahauurkakujiraamaxaaskaqofkadaryeelkabixiyouuaqalkausooguuro.

F Haddii aan sabab fiican la’aanteed shaqada ka joogsado,waxaasuuragalahinlaigajoojiyoGargaarkaCuntada.

F Barnaamijka Gargaarka Cuntada wuxuu leeyahay ciqaab haddii aad sameyso mid ka mid ah waxyaabaha soo socda:

Saxiixayga foomkahn, waxaan fahmay iyo oggolaaday in:

Somali DHS 852 (04/02/09) Page 2Can use (4/09) version

Haddii aad si ula-kac ah sameyso waxyaabaha soo socda...

Waxaa suuragal ah in...

•AadisticmaashokaarkaEBT-gaeeaadanadigu lahayn

•AadkaarkaagaEBT-gakuwareejisodadkale•AadiibsatoamahaysatokaarkaEBT-gaee

aadan adigu lahayn

•Aadtahayeedaysanegalaydembiweynamadhaqanxumi

•Laguganaaxo•Xabbislagugeliyo•Inaadanuqalmingargaarkacuntadainmuddoah

Haddii aad sameyso waxyaabaha soo socda… Waxaad weynaysaa gargaarka cuntada….

•Macluumaadlaqariyoamawarbixinbeenahoolasheego.•Isticmaalkakaarkauuqofkaleleeyahay.•GargaarkaCuntadaoolaguiibsadokhamriamasigaar/tubaako.•InlagaganacsadoamaiibiyoGargaarkaCuntadaamakaararkaEBT.

•12bilooddembigahore.•24bilooddembigalabaad.•Daa’indembigaseddexaad.

•Gargaarkacuntadaoolagubeddeshomaandooriyeyaashasidadaroogada.

•24bilooddembigahore.•Daa’indembigalabaad

•GargaarkaCuntadaoolagubeddeshohub,rasaasamawaxyaabahalaqarxiyo.

•Daa’in

•Ganacsi,iibsashadaamaiibintaGargaarkacuntadaqiimihiisukabadanyahay$500.

•Daa’in

•Bixintamacluumaadbeenaheekusaabsanciddaaadtahayamameesha aad ku nooshahay si aad u hesho Gargaarka Cuntada oo dheeraadah.

•10sanodembikasta

Sidookalewaxaalaguganaaxikaraaillaa$250,000amawaxaalaguxirikaraaillaa20sano,amalabaduba,haddiiaadsameysowaxyaabahaan.Sidookalewaxaasuuragalahinlaguguxukumo

sharciyadaudhiganDawladdaDhexe.

Program Branch Worker ID Case Number

Case Name

(1) Hoyga/Guriga: Macluumaadka aannu hayno waxaysheegayaaninaaddeggantahay:

CinwaankaGuriga Magaalada Gobolka LambarkaXaafadda LambarradaTaleefoonka

CinwaankaWaraaqahaLaguuguSooDiro Magaalada Gobolka LambarkaXaafadda LambarkaTaleefoonka Fariinta

Mabixisaakharashkaguriga?(Haddiiayjawaabtuhaatahay,waxaadbuuxisaahalkahoose)c Haa c Maya c Kirada c Kharashka Iibka Guriga (Haddii aad iibsanayso)Intaaadbilwalbabixiso?Caymiskamilkiilahaguriga,haddiiuuyahayqofkale:Canshuurtahantida,haddiiaygaartahay:$____________ $____________sanadkii $____________sanadkii

(2) Yaa ku nool cinwaankan? (Waxaadsootaxdaaqofkastaooaqalkaagadeggan.)

Somali DHS 852 (04/02/09) Page 3Can use (4/09) versionHalka Dambe u Rog Kana Jawaab Su’aalaha oo Idil. Waxaad Hubisaa in Aad Halka Dambe Saxiixdo Taariikhduna ku Qorto

Waxaad ka jawaabtaa su’aalaha ku saabsan (Bisha Warbixinta):

Miyaad ku nooshahay cinwaankan? cHaa,ugudub(2).cMaya,fadlanintahoosebuuxi.

Maxaadaqalkaagakukululeysaa?c Qoryo c Saliid c Koronto c Gaas cWaxkale_____________Waakharashkakuleyliskaaqalkaookiradakatirsan?c Haa c MayaWaxaadcalaamaysaakharashyadaadeegyadaaadbixisoooidil.c Korontada cTaleefoonkac Biyaha/Qashinka c Qoryo c Gaaska Dabiiciga ah c Baroobayne (Propane) c Qashinka c Saliid

Haddii ay dad dheeraad ah kula deggan yihiin, waxaad soo raacisaa warqad dheeraad ah.

Magaca(magacadambe,magacahore,

billawgamagacadhexe)

Xiriirkaidinka

dhexeeyo

Nooca Jinsiga

(Mid Goobaab Geli)

Taariikhdadhalashada

Miyaad cuntada wadaiibsataaniyo

karsataan?(Mid Goobaab Geli)

LabDheddigAniga H M

H M

H M

H M

H M

H M

H M

Miyuu Doonayaa FS (Gargaarka Cuntada)

iyo/ama ERDC? (Mid Goobaab Geli)

FS ERDC

FS ERDCFS ERDC

FS ERDC

FS ERDCFS ERDC

FS ERDC

(3) Miyuu jiraa qof meel kale ay lacag ka soo gasho? c Haa c Maya (Haddii ay jawaabtu tahay haa, waxaad buuxisaa inta hoos ku taal. Waxaad soo raacisaa wixii caddayn ah) Tusaaleahaanwaxaakamidah: •LambarkaDaryeelkaBulshada •GunnadaShaqoLa’aanta•GunnadaHawlgabkaCiidanka•MasruufkaCarruurta •GunnadaMagdhawgaShaqaalaha •Amaah/Haddiyad

Magaca Qofka Lacag Dheeraad ah Haysto

Meesha ay ka Timid Lacagta Kale

Sida Joogtada ah ee Loo Siiyo?

Miyeey Socon Doontaa?

Inta ay Tahay Qayb Kasta oo

La Siiyo

Inta ay Ahayd Bishan

c Haa c Maya*c Haa c Maya*c Haa c Maya*

*Haddiiuuisbeddelidoonodakhliga,waxaadsheegtaaintauunoqondoonodakhligacusub.Waamaxaysababta isbeddelka goorma ayuu isbeddelka dhici doonaa?

$$$

$$$

LabDheddig

LabDheddig

LabDheddig

LabDheddig

LabDheddig

LabDheddig

(4) Ma jiraa qof shaqeeyo? (Ardayda waxaad raacisaan shaqada waxbarashada ku saabsan)/Haddiiayjawaabtuhaatahay,waxaadbuuxisaahalkahoose. c Haa c MayaWaxaadqortaashaqooyinkauuqofkastashaqeeyo.Waxaad Soo Raacisaa Wixii Caddeyn ah ee ku saabsan dakhliga soo galay bisha warbixinta(bishawarbixintawaxaykutaaldushaBogga3-aad).

AKHRI iyo SAXIIX: Macluumaadkaaanfoomkankubixiyeywaakuwosaxahoodhammeystiran.Waxaanakhriyayfoomkanafartiisabogooidilwaanafahanay.Waxaankularaacsanahayshuruudahakuyaalbogga2-aad.

Somali DHS 852 (04/02/09) Page 4Can use (4/09) version

SaxiixaQofkaFoomkanBuuxinaya TaariikhdaTaleefoonka

Asalka: Galka Kiiska

Haddii aad gaar u shaqeysato, waxaad calaameysaa halkaan c Shaqada 1-aad Shaqada 2-aad Shaqada 3-aad

QofkashaqeeyoMagacaiyolambarkataleefoonka shaqadaDarajadashaqadaMushaharka saacaddii $ $ $Haddiimushaharkaaguaannukusaleysnaynsaacaddii,waxaadhalkankusharraxdaadakhligaaga:Saacadaha (asbuucii)Sidajoogtadaaheeloosiiyo? (asbuucii,bishii)Maalmaha mushaharka?MaanjadaasbuuciiLacagtahorumarkaah,gunnadaabaalma-rinta ama dallaalka? $ $ $

Ma sii socon doontaa? c Haa c Maya* c Haa c Maya* c Haa c Maya**Haddiiuudakhligaisbeddelidoono,waxaadhalkankuqortaasababtaisbeddelka:

Tiradacusub? $ $ $Taariikhdaisbeddelka?

Haddii aad qaadato Gargaarka Cuntada oo kaliya, waxaad ka gudubtaa su’aalaha (6) iyo (7).(6) Ku saabsan daryeelka xanaanada carruurta, waxaad fadlanqortaamacluumaadkakusaabsanjadwalkashaqadaadaiyodaryeelkaxanaanada:Saacada Shaqada: KaBillaabata:____________am/pm Ku:____________am/pm

Maalmaha Shaqada: c Isniin cTalaado cArbaco c Khamiis c Jimco c Sabti cAxad

Jadwal Kale (Sharrax):_______________________________________________________________________

Daryeelaha Xanaanada:___________________________________LambarkaTaleefoonka:__________________

Dayeelaha Xanaanada Labaad:_____________________________LambarkaTaleefoonka:__________________

(5) Bixinta Lacagta Masruufka Carruurta: Haddiiqofkulanoolaymaxkamadkuamartayinuubixiyomasruufkacarruurta,amarkamaxkamaddamiyuuisbeddelay? c Haa cMaya Haddiiayjawaabtuhaatahay,tiradabishii$_________________

(7) Ma jiraa carruur u baahan xanaano gaar ah? c Haa c Maya Haddii ay jawaabtu haa tahay,waaqofma?_________________________________________