BIU MU 1

STT

Yu cu, cu
hi

1.

S h s

2.

Tn C quan
UBND X TNH THI
thng k

3.

Tn th tc
hnh
chnh Ch hng tr cp x hi (ti cng ng)
(TTHC)

4.

Lnh
vc
Bo tr x hi
thng k

5.

Trnh t thc Bc 1:- Ngi c yu cu hng tr cp x hi ti cng

hin
ng n np h s cho cn b lao ng thng binh x hi,
cn b lao ng thng binh x hi hng dn ngi dn
vit mu theo quy nh.
Bc 2 : Cn b lao ng thng binh x hi kim tra ni
dung n y v tip nhn h s.
Bc 3 : Cn b lao ng thng binh x hi phi hp vi
cc ban ngnh on th x hp Hi ng xt duyt tr cp
x hi.
- Trong trng hp i tng khng tiu chun theo quy
inh thi Uy ban nhn dn cp xa thng bao cho i tng
bitbng vn bn; trng hp co y kin thc mc, khiu nai,
t cao cua nhn dn thi Uy ban nhn dn cp xa phai thm
tra va thanh lp Hi ng xet duyt gii quyt theo n
khiu ni, t co ca i tng.
-Trng hp xt thy tiu chun th nim yt cng
khai ti tr s y ban nhn dn x v thng bo trn cc
thng tin i chng ca x ( nu c) v trch yu l lch ca
i tng, ni dung ch tr cp ngh c hng. Sau
thi gian 30 ngy k t ngy nim yt cng khai, nu khng
c kin thc mc, khiu ni th cn b lao ng thng
binh x hi hon thin h s ca i tng theo quy nh v
gi v Phng Ni v - Lao ng- Thng binh x hi cp
Huyn xem xt gii quyt.
- Khi nhn c quyt nh ca c quan cp trn, cn
b lao ng thng binh x hi thng bo cho i tng v

hng dn Phng Ni v - Lao ng- Thng binh x hi

nhn ch tr cp x hi ti cng ng.
Thi gian tip nhn : Sng t 7h 30 n 11gi bui chiu t
13 h 30 n 16h 30 t th hai n th su.
Thi gian tr kt qu : Sng t 7h 30 n 11gi bui chiu
t 13 h 30 n 16h 30 t th hai n th su
6.

Cch
thc
Tr s c quan hnh chnh.
thc hin
a)Thnh phn h s bao gm:
- n ngh hng tr cp x hi. (biu s 1)
- S yu l lch ca i tng tr cp ( biu s 11)
- Vn bn xc nhn ca c quan y t c thm quyn v tnh
trng tn tt i vi ngi tn tt (nu c), ngi tm
thn,ngi nhim HIV/AIDS
- Bin bn hp hi ng xt duyt tr cp x hi ( mu s 2)
* i vi trng hp nhn nui dng tre em m ci,
tre em bi bo ri ngoai h s nu trn con co:
- n ca ngi nhn nui c kin ng y cho
nhn nui cua ngi giam h hoc ngi ang nui dng
tre em m ci, tre em bi bo ri; trng hp tre em t u 9
tui tr ln phai c s ng y cua tre em trong vn ban
nay (mu s 1b); xc nhn ca Trng thn v kin chp
thun ca U ban nhn dn cp x ni tr em sinh sng;
- Ban sao giy khai sinh; s yu ly lich cua tre em;
- S yu ly lich cua ca nhn hoc chu h gia inh
nhn nui dng tre em co xac nhn cua Uy ban nhn dn
cp xa ni c tru, kem theo ban sao cng chng giy chng
minh nhn dn.
b) S lng h s: l b.

7.

H s

8.

Thi hn gii
Trong vng 40 ngy ( thi gian nim yt 30 ngy)
quyt

9.

10

C quan thc
hin TTHC

i tng
thc hin
TTHC

a) C quan c thm quyn quyt nh: UBND thnh ph Cao Lnh

b) C quan hoc ngi c thm quyn c y quyn hoc phn cp
thc hin ( nu c):
c) C quan trc tip thc hin TTHC: UBND X Tnh Thi
d) C quan phi hp ( nu c): Cc ban nghnh on th x.

C nhn

T chc

TTHC ny c C

11.

yu cu phi
hon thnh
mu n,
mu t khai
khng?

- n ngh hng tr cp x hi.

(biu s 01).
- Bin bn hp hi ng xt duyt tr Ti im a, khon 1, mc
III thng t ca B lao
cp x hi (mu s 2)
ng thng binh v x hi
s : 09/TT-BLTBXH
- S yu l lch ca i tng tr m ci ngy 13/7/2007 hng dn
mt s iu ca Ngh nh
(biu s 11)
s : 67/2007/N-CP ngy
13/4/2007 ca chnh ph v
chnh sch tr gip cc i
- n nhn nui tr em m coi hoc b tng bo tr x hi.
ri (mu s 1b).

Khng
C

12.

Ph, l ph

13.

giy php
giy chng nhn
giy ng k
chng ch hnh ngh
th
ph duyt
Kt qu ca chng ch
vic thc hin vn bn xc nhn
TTHC
quyt nh hnh chnh
giy xc nhn
bn cam kt
bin hiu
vn bn chp thun
bng
loi khc:

14.

Khng

ghi r :

4
- Tr em m ci c cha v m, tr em b
b ri, mt ngun nui dng; tr em m
ci cha hoc m nhng ngi cn li l
m hoc cha mt tch theo quy nh ti
iu 78 ca B lut Dn s hoc khng
nng lc, kh nng nui dng
theo quy nh ca php lut; tr em c
cha v m, hoc cha hoc m ang trong
thi gian chp hnh hnh pht t ti tri
giam, khng cn ngi nui dng; tr
em nhim HIV/AIDS thuc h gia nh
ngho.
- Ngi cha thnh nin t 16 n
di 18 tui nhng ang i hc vn ha,
hc ngh, c hon cnh nh tr em nu
trn.
- Ngi cao tui c n, thuc h gia
nh ngho; ngi cao tui cn v hoc
chng nhng gi yu, khng c con,
Ngoi
quy chu, ngi thn thch nng ta,
nh v th thuc h gia nh ngho (theo chun Ti iu 4, chng II
tc, c yu ngho c Chnh ph quy nh cho ca Ngh nh s :
tng thi k).

cu hoc iu
kin no
c cp mt
trong cc loi
giy nu ti
cu hi 13
hay khng?

67/N CP, ngy

- Ngi t 85 tui tr ln khng c lng 13/4/2007 ca Chnh

hu hoc tr cp bo him x hi.
ph V chnh sch tr gip
- Ngi tn tt nng khng c kh nng cc i tng bo tr x
lao ng hoc khng c kh nng t hi.
phc v, thuc h gia nh ngho.
- Ngi mc bnh tm thn thuc cc
loi tm thn phn lit, ri lon tm thn
c c quan y t chuyn khoa tm
thn cha tr nhiu ln nhng cha
thuyn gim v c kt lun bnh mn
tnh, sng c thn khng ni nng ta
hoc gia nh thuc din h ngho.
- Ngi nhim HIV/AIDS khng cn
kh nng lao ng, thuc h gia nh
ngho.
- Gia nh, c nhn nhn nui dng tr
em m ci, tr em b b ri.
- H gia nh c t 02 ngi tr ln tn
tt nng, khng c kh nng t phc v.
- Ngi n thn thuc din h ngho,
ang nui con nh di 16 tui; trng
hp con ang i hc vn ho, hc ngh
c p dng n di 18 tui.

Khng

Tn, s, k hiu, ngy

ban hnh, ngy c hiu
lc:

Loi vn bn php lut

Lut cua Quc hi
Ngh quyt ca Quc hi
Php lnh ca U ban Thng
v Quc hi
Ngh quyt ca U ban
Thng v Quc hi

Nghi inh cua Chinh phu

Ngh nh s : 67/N
CP, ngy 13/4/2007
ca Chnh ph V chnh
sch tr gip cc i tng
bo tr x hi.

Ngh quyt ca Chnh ph

Quyt nh ca Th tng
Chnh ph
15.

Ch th ca Th tng Chnh
Cn c php
ph
l ca TTHC
Quyt inh cua B trng
Ch th cua B trng

Thng t cua B trng

Thng t lin tch ca cc B

Ngh quyt cua HND
cp ......
Quyt nh cua UBND cp
Tnh ng Thp.
Ch th cua UBND
cp .............
Vn bn khc

Thng t ca B lao ng
thng binh v x hi s :
09/TT-BLTBXH
ngy
13/7/2007 hng dn mt
s iu ca Ngh nh s :
67/2007/N-CP
ngy
13/4/2007 ca chnh ph v
chnh sch tr gip cc i
tng bo tr x hi.

16.

- H tn: Nguyn Thanh Hng

tin - a ch c quan: UBND X Tnh Thi
- S in thoi c quan: 067.3885.387 v 067.3885.287
- a ch email: tthoi@caolanhcity.dongthap.gov.vn.

Thng
lin hc

Biu mu ny c np mt bn giy v mt bn di dng file in t cho T cng

tc.
Mu s: 1
( Ban hnh theo Thng t s: 09 /2007 /TT.BLTBXH, ngy 13 / 7 /2007 )

CNG HO X HI CH NGHA VIT NAM

c lp - T do - Hnh phc.
. . . . . . . . . . , ngy

thng

nm 200

N NGH HNG TR CP X HI
( p dng cho nhm i tng tr em: M ci, tr b b ri, tn tt nng,
nhim HIV/AIDS, ngi n thn nui con nh ).
1. Ti tn l: ............................................................................, Nam ( N ): ..............................
Sinh ngy: ............................ thng ............................... nm .....................................................
Qu qun: .....................................................................................................................................
CMND s: ......................................... , cp ngy .......... thng ........... nm ..............................
Hin c h khu thng tr ti: s nh ............, t ..........., p ( khm ): ..................................
x ( phng, th trn ) :............................., huyn ( TX, TP ): ....................., tnh ng Thp
2. Thuc din: h ngho
;

; s s h ngho

; cp ngy

/ 200

tr c hon cnh cuc sng kh khn

3. Thuc nhm tui: di 18 thng tui

; t 18 thng tui n di 16 tui

t 16 n di 18 tui
4. Trnh trng hc vn, hc ngh: cn ang i hc vn ho hoc hc ngh
( p dng cho nhm tr t 16 n di 18 tui )
5. Thuc i tng: tr b b ri hoc m ci

; tr tn tt nng

; nhim

HIV/AIDS
Nu hon cnh c nhn, gia nh, dng i tng:
......................................................................................................................................................

......................................................................................................................................................
......................................................................................................................................................
......................................................................................................................................................
......................................................................................................................................................
......................................................................................................................................................
......................................................................................................................................................
......................................................................................................................................................
......................................................................................................................................................
......................................................................................................................................................
Vy ti lm n ny ngh :
......................................................................................................................................................
......................................................................................................................................................
......................................................................................................................................................
Xc nhn ca Trng p ( khm )
Xc nhn trng hp ng ( b ):
.............................
nu trn l ng ngh UBND x ( P, TT ),
huyn xem xt cho . . . . . . . . . . . . . . . . .
Trng khm ( p )

Ngi vit n
( K ghi r h tn )

Xc nhn v ngh ca UBND cp x ( Ph, TT ):

UBND . . . . . . . . . . . . . . . . . . . . .
Cn c h s v kt qu nim yt cng khai ti
tr S UBND x ( Ph, TT ) . . . . . . . . . . . . . . . . . . . .
v thng bo trn cc phng tin thng tin ca x
( Ph, TT ) . . . . . . . . . . . . . . . . . t ngy . . / . . / . . .
ngh Ch tch UBND huyn ( th, TP ) xem xt
Quyt nh.
TM. UBND x ( Ph, TT ): . . . . . . . . . . .
CH TCH

Biu s 11
UBND TNH NG THP
NAM
Huyn, th: . . . . . . . . . . . . . . . . . .

CNG HA X HI CH NGHA VIT

c lp - T do - Hnh phc.

UBND x, phng, TT: . . . . . . . .

S YU L LCH
i tng: TR M CI

B b ri, tn tt nng, nhim

HIV/AIDS.
( p dng cho tr em di 18 tui )
*********
- H v Tn: .......................................................Nam, N: .......................................
- Nm sinh:............, trnh hc vn ( lp ): ..... , ang hc
, ngh hc
- Ngh nghip: Cha c ngh
, ang hc ngh
, ngnh ngh ang
hc:
......................................................................................................................................
- Dn tc: ............................................................
Tn
gio:
.............................................................................
Ni
sinh:
......................................................................................................................................
Ni
c
tr
hin
nay:
......................................................................................................................................
Tr
thuc
i
tng:
......................................................................................................................................
HON CNH GIA NH
1/ H Tn cha:........................................................................ Nm sinh: ..................................
- Lm g:............................................................ u: ...............................................................
- Cht nm no:................................................. l do cht: ........................................................
2/ H Tn m:........................................................................ Nm sinh: ..................................
- Lm g:............................................................ u: ...............................................................
- Cht nm no:................................................. l do cht: ........................................................
- L do khc:.................................................................................................................................
3/ Cc anh ch em rut:........................................................... Nm sinh: ................................
- Lm g: ............................................................. u: .............................................................
-.....................................................................................................................................................
-.....................................................................................................................................................
-.....................................................................................................................................................
4/ Bn thn:
- Sc khe ( cc loi bnh ): ........................................................................................................
- vi ai ( H Tn ): ...................................................................................................................
- Quan h vi ngi ang nui dng: .......................................................................................
- Hin ang hng ch g ca nh nc: ................................................................................
- Ti sn c g: .............................................................................................................................
Ti cam oan li khai trn l ng.
___________, ngy
thng nm 200 _
Ngi lp phiu
UBND x, phng, TT: _____________
CH TCH

Mu s 2
CNG HO X HI CH NGHA VIT NAM

c lp - T do - Hnh phc
BIN BN
HP HI NG XT DUYT TR CP X HI
Hm nay, vo hi .........gi..........ngy ............thng...........nm 200...................
ti ...............................................................................................................................
Chng ti, gm:
1. ng (b).............................................Ch tch UBND x ................................
Ch tch Hi ng xt duyt tr cp x hi
2. ng (b) ..................................Cn b LTBXH, thng trc Hi ng;
3. ng (b).................................Ch tch Mt trn T quc x, Thnh vin;
4. ng (b) ................................. i din................................. Thnh vin;
5. ng (b) ..................................i din................................. Thnh vin;
6. ng (b) ..................................i din................................. Thnh vin;
hp Hi ng xt duyt tr cp x hi (thng xuyn, t xut hoc a vo
Nh x hi, C s bo tr x hi) xem xt nhng ni dung sau:
1.............................................................................................................................
.
2. ...........................................................................................................................
.
3. ...........................................................................................................................
.
Hi ngh thng nht mt s kt lun sau:
a) Cc trng hp tiu chun hng tr cp (thng xuyn, t xut hoc
a vo Nh x hi, c s bo tr x hi):
1.............................................................................................................................
.
2. ...........................................................................................................................
.
b) Cc trng hp cha tiu chun hng tr cp (thng xuyn, t xut
hoc a vo Nh x hi, c s bo tr x hi):
1.............................................................................................................................
.
L do:.....................................................................................................................

10

2. ...........................................................................................................................
.
L do:..................................................................................................................
Hi ngh nht tr ngh Ch tch U ban nhn dn x xem xt, ngh cp c
thm quyn quyt nh.
Hi ngh kt thc hi .........gi......ngy........thng......nm 200.....
Bin bn ny c lm thnh 04 bn, gi UBND huyn 02 bn (qua Phng Ni
v-Lao ng-Thng binh v X hi) v lu ti x 02 bn.
TH K HI NG
(K, ghi r h tn)

CH TCH HI NG
(K, ghi r h tn v ng du)

CNG HA X HI CH NGHA VIT NAM

c lp T do Hnh phc

Mu s 1b

..........................., ngy ..... thng ..... nm 200....

N NHN NUI TR EM M CI, B B RI
Knh gi: - U ban nhn dn x (phng, th trn) .........................................................................
- y ban nhn dn huyn (qun, th x, thnh ph) .................................................................
Tnh, thnh ph .......................................................................................................................
Tn ti l: ..................................................Nam, n ........................................................................
Hin c h khu thng tr ti .........................................................................................................
X (phng, th trn) .............................. huyn (qun, th x, TP) ................................................
Tnh ...................................................................................................................................................
Giy chng minh nhn dn s .................................. do CA ..................................cp
ngy ......... thng .......... nm ..................
xin ngh UBND x ................................... UBND huyn ...........................................................
cho php ti c nhn nui chu: ...................................................................................................
hin :.................................................................................................................................................
sinh ngy ....... thng ...... nm 200... l tr em m ci c cha ln m (hoc b b ri).
Ti xin cam oan s nui dng, chm sc chu v bo m cho chu c thc
hin quyn ca tr em.
kin ca ngi gim h v tr em c nhn nui
(trng hp tr em t 9 tui tr ln)

Ngi vit n
(k, ghi r h tn)

11
............................................................................ ......
...................................................................................
...................................................................................
(k, ghi r h tn)

kin chp thun ca U ban nhn dn cp x

UBND x: ........................................................
ng ngh cho ng b: ................nhn nui
chu ........................................ theo n ngh
Ch tch UBND x

Xc nhn ca Trng thn,

xc nhn trng hp ................
hin c tr ti thn ..................
(K, ghi r h tn)