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Revision 10-1; Effective January 1, 2010
C—610 General Information
Revision 02-3; Effective April 1, 2002
All Programs
This section contains Form H1000-A, Notice of Application, and Form H1000-B, Record of Case Action, entries for certifications, actions taken during certification periods, and denials. For transfer entries, refer to C-700, Transfer Guidelines.
C—620 Certification Entries
Revision 02-3; Effective April 1, 2002
C—621 Minimum Entries for Certification
Revision 02-3; Effective April 1, 2002
C—621.1 TANF Minimum Entries
Revision 02-3; Effective April 1, 2002
TANF
| Section I | |
|---|---|
| Item 02 Item 07 Item 08 Item 09 Item 13 Item 15 Item 16 Item 17 Item 25 |
Category Mail Code Date Filed Case Name Mailing Address City State ZIP Code County |
| Section II | |
| Item 32 Item 33 Item 34 Item 35 Item 37 Item 38 |
Client Number Client Name Birth Date Sex Social Security Number (if known) Social Security Claim Number (if enrolled in Medicare or receiving benefits) |
| Section III | |
| Item 40 Item 41 Items 42-44 Item 46 |
Status in Group ESP Code (unless Category 5) Individual Income, if applicable Medical Effective Date |
| Section IV | |
| Item 55 Item 56 Item 58 Item 59 |
Total Railroad Retirement (if appropriate) Total Other (Income) (if appropriate) Dependent Care Deductions (if appropriate) Adjusted Gross Income |
| Note: Total income minus deductions must equal adjusted gross income | |
| Section V | |
| Item 66 | Total Needs |
| Section VIII | |
| Item 127 Item 129 Item 132 Item 133 Item 134 Item 138 Items 149, 151, and 152 |
Type Program Grant Effective Date Action Code Three Months Prior Indicator (only if eligible for three months prior medical assistance) Three Months Prior Application Date (if entry made in Item 133) Child Support Cooperation For cases with earned income, enter dependent care and 90% earned income deduction information if these deductions are used in determining the adjusted gross |
| Section XIV | |
| Item 188 Item 189 Item 190 |
Signature Date Signed Employee Number |
C—621.2 SNAP Minimum Entries
Revision 02-3; Effective April 1, 2002
SNAP
| Section I | |
|---|---|
| Item 02 Item 04 Item 06 Item 07 Item 08 Item 09 Item 13 Item 15 Item 16 Item 17 Item 25 |
Category Page number and the number of pages if there are more than 11 individuals Budgeted Job Number Mail Code Date Filed Case Name Mailing Address – first line City State ZIP Code County |
| Section II | |
| Item 32 Item 33 Item 34 Item 35 Item 36 Item 37 Item 38 Item 39 |
Client Number Client Name Birth Date Sex (if known) Race (if known) Social Security Number Social Security Claim Number (if visually verified) Education Level (if Item 41 is 1, 2, 3, or 4) |
| Section III | |
| Item 40 Item 41 Items 42-45 Item 48 Item 49 |
Status in Group Work Registration Individual Income, if applicable Medical Cost of eligible members as appropriate Disqualification Code and Date, if applicable |
| Section IV | |
| Item 55 Item 56 Item 58 Item 59 |
Total Railroad Retirement (if appropriate) Total Other (Income) (if appropriate) Dependent Care Deduction (if any) Adjusted Gross Income |
| Section V | |
| Item 60 Item 63 |
Shelter Net Income |
| Section VI | |
| Item 78 Item 79 Item 80 Item 81 Item 82 Item 83 Item 84 Item 85 Item 89 Item 90 Item 91 Item 92 Item 96 Items 103 and 104 |
Type Review Application Codes Certification Date Months Certified Last Benefit Month Household Number Aid Type Test (Gross/net income eligibility test identifier codes) SSI Code (if applicable) Utility Code Action Code (if case is opened and closed on same document) Action date (if entry made in Item 91) Late Determination/Rescheduled Appointment Date, if applicable (if appropriate) |
| Section VII | |
| Items 112 and 113 Items 118-122 |
Associated TANF case numbers, if appropriate (if appropriate) |
| Section VIII | |
| Item 152 | Child Support Disregard, if applicable |
| Section XI | |
| Items 179-187 | As appropriate to request or report benefits |
| Section XIV | |
| Item 188 Item 189 Item 190 |
Signature Date Signed Employee Number |
C—621.3 Minimum Entries for Medical Programs
Revision 02-3; Effective April 1, 2002
Medical Programs except TP 45
| NOA Entries | |
| Section I | |
|---|---|
| Item 01 Item 02 Item 03 Item 06 Item 07 Item 09 Item 12 Item 13 Item 15 Item 16 Item 17 Item 25 Item 31 |
Case Number Category Prior Recipient Budgeted Job Number Mail Code Case Name Employee Number Mailing Address City State ZIP Code County Medical Programs Application Number |
| Section II | |
| Items 33-38 | Client Names and Biographical Data |
| Certification Entries | |
|---|---|
| Section I | |
| Item 02 Item 07 Item 08 Item 09 Item 13 Item 15 Item 16 Item 17 Item 25 Item 29 Item 30 |
Category Mail Code Date Filed Case Name Mailing Address City State ZIP Code County Notice Date Medical Delay (if appropriate) |
| Section II | |
| Item 32 Item 33 Item 34 Item 35 Item 37 Item 38 |
Client Number Client Name Birth Date Sex Social Security Account Number (if known) Social Security Claim Number (if enrolled in Medicare or receiving benefits) |
| Section III | |
| Item 40 Items 42-44 Item 46 |
Status in Group Individual Income, if applicable Medical Effective Date |
| Section IV | |
| Items 55, 56, and 58 Item 59 |
Case Income, if applicable Adjusted Gross Income |
| Note: Total income minus deductions must equal adjusted gross income. | |
| Section V | |
| Item 66 | Total Needs |
| Section VII | |
| Item 125 Item 126 |
Number of Adults Number of Children |
| Section VIII | |
| Item 127 Item 132 Item 133 Item 134 Item 136 |
Type Program Action Code Three Months Prior Indicator only if eligible for three months prior medical assistance Three Months Prior Application Date (if entry is made in Item 133) Medicaid Termination Date |
| Section XIV | |
| Item 188 Item 189 Item 190 |
Signature Date Signed Employee Number |
C—621.3.1 TP 45 Minimum Entries
Revision 02-3; Effective April 1, 2002
TP 45
| Section I | |
|---|---|
| Item 02 Item 07 Item 08 Item 09 Item 13 Item 15 Item 16 Item 17 Item 25 Item 29 |
Category Mail Code Date Filed Case Name Mailing Address City State ZIP Code County Notice Date |
| Section II | |
| Item 32 Item 33 Item 34 Item 35 Item 37 |
Client Number Client Name Birth Date Sex Social Security Account Number (if known) |
| Section III | |
| Item 40 Item 46 |
Status in Group Medical Effective Date |
| Section VIII | |
| Item 127 Item 132 |
Type Program Action Code |
| Section XIV | |
| Item 188 Item 189 Item 190 |
Signature Date Signed Employee Number |
C—622 Entries for Three Months Prior
Revision 02-3; Effective April 1, 2002
C—622.1 Three Months Prior Medicaid – Currently Eligible – No Gap in Coverage
Revision 02-3; Effective April 1, 2002
TANF
Complete Form H1000-A, Notice of Application, using TANF entry requirements.
Item 46 – Enter prior medical effective dates for applicants eligible for three months prior medical coverage.
Item 133 – Enter the number of months of prior eligibility.
Item 134 – Enter three months of prior application date.
Note: For three months prior with a gap in coverage, see C-623.2.
C—622.2 Three Months Prior Entries for a Medically Needy Case
Revision 02-3; Effective April 1, 2002
TP 55 and 30
Make minimum certification entries for a case with or without spend down. For a TP 30 case, do not make entries in Items 179-187 if Item 137 has an entry of 40, 43, 44, or 48. Refer to Form H1000-A and Form H1000-B instructions for Items 133 and 137.
Make the following entries in Section XI when there is no gap in eligibility during the prior period:
Item 179 – Enter N if the prior month has spend down or E if the prior month does not have spend down. This code corresponds with the month entered in Item 183.
Item 183 – Enter the month to correspond with the code in Item 179.
Item 184 – Enter the net income to correspond with the month in Item 183. Round down to the whole dollar amount.
Item 185 – Enter the spend down amount to correspond with the month entered in Item 183. Enter 0 if there is no spend down.
Item 187 – Enter the household size to correspond with the month entered in Item 183. Enter the number of adults in the budget group in the first digit and the number of children in the budget group in the second digit.
If there is a gap in eligibility during the three-month prior period, process a separate Form H1000-A for the eligible months.
C—623 Entries for Open and Close Certifications
Revision 02-3; Effective April 1, 2002
C—623.1 TP 04, Medical Assistance Only – Deceased
Revision 02-3; Effective April 1, 2002
TANF
Make TANF minimum entries except for Items 41 and 129
Item 40 – Enter X with status in group code for deceased individual.
Item 46 – Enter the medical effective date for each eligible person.
tem 47 – Enter the appropriate dates.
Item 132 – Enter action code 090.
Item 133 – Enter three months prior indicator, if eligible.
C—623.2 TP 11, Three Months Prior Medical Assistance – Not Currently Eligible; Gap in Coverage; or Reopened Applications
Revision 02-3; Effective April 1, 2002
TANF
Make all TANF minimum entries except Items 41 and 129.
For reopened applications,
Item 08 – Enter the date the applicant requests the application be reopened.
Item 134 – Enter the month and year the original application was filed.
Item 140 – Enter M with primary Codes 5, 6, 7, or 8 for applicants eligible for retroactive coverage. Enter N with primary Codes 5, 7, or 8 for applicants who are not eligible for retroactive coverage but are included to show need.
Item 47 – Enter last day of medical coverage for all applicants with Code M in Item 40.
Item 132 – Enter Code 090.
Notes:
- Enter MX with primary codes for an applicant who dies during the three month prior period or if the person died before the application was made on his behalf.
- For Three Months Prior Currently Active – In addition to the above entries, enter the existing case number in Item 01 and the existing client number in Item 32.
C—623.3 Simultaneous Open and Close for TANF
Revision 02-3; Effective April 1, 2002
TANF
Use this procedure to process applications for
- denied households eligible for restored benefits (See B-800, Restored Benefits),
- applicants eligible for TANF for the current month but ineligible for future months,
- applicants eligible for OTTANF, or
- applicants eligible for TANF Medicaid for the application month but ineligible for the months following the application month.Note: Form H1000-A, Notice of Application, can be processed only if the month after the application month is entered in Item 129.
Make all minimum entries for the appropriate type program.
Note: Do not reassign an old case number.
Item 40 – Enter secondary status in group Code N for OTTANF applicants.
Item 47 – Enter last month of eligibility for each certified person. If an applicant is deceased, enter date of death.
Item 127 – enter Type Program 71 or 72 for OTTANF cases.
Item 132 – Enter Code 090.
Items 179, 180, 183, 184, 185 and 187 (Section XI) – Enter information to authorize benefits for Type Program 01 and 61 certifications. Exceptions: Do not make entries in Section XI for OTTANF cases. When the form processes, benefits are automatically issued.
C—623.4 Simultaneous Open and Close for Medical Programs
Revision 02-3; Effective April 1, 2002
Medical Programs
Use this procedure to process applications for
- TP 55 and 30 with spend down in the application month;
- TP 30 when the applicant is a caretaker or a second parent with an emergency condition; or
- three months prior only including
- TPs 30 and 55 with or without spend down, and
- applications for TPs 30, 40, 43, 47, 48, and 55 reopened within two years after the original application was filed.
Make minimum certification entries for a case (with or without spend down) including the file date of the application. Note: Do not reassign an old case number.
Item 40 – Enter the appropriate SIG codes. For three months prior, only include in the certified group members who have Title XIX-reimbursable bills for the prior period. For TP 30, include only one member in the certified group.
Item 46 – Enter the Medical Effective Date (MED) or earliest possible MED. For TP 30 cases, enter the start date of the emergency condition taken from Form H3038, Emergency Medical Services Certification.
Item 47 – Enter the last day of medical coverage. For TP 30 cases enter the earliest of either
- the end date of the emergency condition, or
- the last day of the application month.
Note: For TP 55 cases with spend down, computer edits will not allow a date later than the last day of the application month.
Item 66 – Enter the correct needs allowance for the month(s) entered in Items 46 and 47.
Item 127 – Enter the correct type program (30, 40, 43, 44, 47, 48, or 55).
Item 132 – Enter code 090.
Item 133 – For three months prior only, enter the total number of unduplicated calendar months of three months prior.
Item 137 – For TP 30 cases, enter the appropriate TP. Refer to Form H1000-A and Form H1000-B instructions for this entry.
Section XI – For three months prior only, make appropriate entries for each of the prior months. For TP 30 cases, do not make these entries if Item 137 has an entry of 40, 43, 44, or 48.
For reopened three months prior applications,
Item 08 – Enter the date the applicant requests the application be reopened.
Item 134 – Enter the month and year the original application was filed.
C—624 Entries for Reinstatements
Revision 02-6; Effective July 1, 2002
C—624.1 TANF
Revision 10-1; Effective January 1, 2010
Make all Form H1000-A minimum entries.
Item 01 – Enter the previous case number.
Item 08 – Enter first day of the month of reinstatement.
Item 46 – Enter each individual's medical effective date.
Item 131 – Enter type review Code C.
Item 132 – Enter Code 054 or 055.
Item 164 – Enter the three-digit code for the individual's county of residence. See C-350.
Note: SAVERR edits prevent household additions when Code 054 is used in Item 132. Use Form H1000-B turnaround to make this change.
C—624.2 SNAP
Revision 10-1; Effective January 1, 2010
SNAP
Item 08 – Enter the original file date.
Item 79 – Enter 3X0.
Item 80-82 – Reenter the information from the certification period when the case was denied.
Section XI – Make entries as appropriate to order benefits.
C—624.3 TP 07/20 (Four, 12, or 18 Months Medicaid) for a Case Previously Denied in Error
Revision 10-1; Effective January 1, 2010
TANF
Make all TANF minimum entries except Items 41 and 129.
Item 01 – Enter case number of the case denied in error.
Item 32 – Enter each individual's previous client number.
Item 46 – Enter each individual's medical effective date as the day after the date the erroneous denial became effective.
Item 132 – Enter
- Code 090 if the Medicaid end date is before the current process month, or
- Code 055 if the Medicaid end date is during or after the current process month.
Item 136 – Enter the Medicaid end date.
Item 138 – Enter the reason for transfer to TP 07 or TP 20.
Item 164 – Enter the three-digit code for the individual's county of residence. See C-350.
C—624.4 TP 37 (12 or 18 Months Medicaid) for a Case Previously Denied in Error
Revision 10-1; Effective January 1, 2010
TANF
Make all TANF minimum entries except Items 41 and 129.
Item 01 – Enter case number of the case denied in error.
Item 32 – Enter each individual's previous client number.
Item 46 – Enter each individual's medical effective date as the day after the date the erroneous denial became effective.
Item 132 – Enter
- Code 090 if the Medicaid end date is before the current process month, or
- Code 050 if the Medicaid end date is during or after the current process month, or
- Code 054 to reinstate a denied household that meets the requirements in A-800.
Item 149 – Enter Code 9 for the 90% Earned Income Deduction (EID).
Item 151 – Enter the original date of the 90% EID. Do not enter a dollar amount in Item 152.
Item 164 – Enter the three-digit code for the individual's county of residence. See C-350.
C—624.5 Reinstatement for Post Medicaid (TP 20), Transitional Medicaid (TP 07 or 37), or TP 29
Revision 10-1; Effective January 1, 2010
TANF
Make all TANF minimum entries.
Item 01 – Enter the previous case number.
Item 08 – Enter the first day of the month of reinstatement.
Item 46 – Enter each individual's medical effective date.
Item 131 – Enter Type Review Code C.
Item 132 – Enter Code 054 or Code 090.
Item 136 – TP 07, TP 20, or TP 29: Enter
- the original end date as shown on SAVERR, or
- an earlier end date, when applicable, when using Code 090.
Item 138 – Enter
- S for TP 20, or
- E or B for TP 07.
Item 151 – Enter the original date of the 90% EID. Do not enter a dollar amount in Item 152.
Item 164 – Enter the three-digit code for the individual's county of residence. See C-350.
Note: SAVERR edits prevent the actions listed below when Code 054 is used in Item 132. Therefore, use Form H1000-B turnaround to
- add a person.
- correct the end date of the original TP 07, TP 29, or TP 37 period. Change the end date only if it was incorrect when the case originally transferred to transitional Medicaid.
C—625 Miscellaneous Certification Entries
Revision 02-3; Effective April 1, 2002
C—625.1 Certifying Benefits for the Month After Certification
Revision 02-3; Effective April 1, 2002
TANF
Make all minimum TANF entries.
Item 46 – Enter first calendar day of the month after the application month.
Item 129 – Enter first calendar day of the month after the application month.
Note: Do not make future grant or medical effective dates for TANF more than one month past the future cutoff month.
C—625.2 Certifying a TP 29 Case
Revision 02-3; Effective April 1, 2002
TANF
Certify only one individual on each TP 29 case.
Item 40
- For the individual being certified on TP 29 enter
- SIG 8G if the individual was SIG 8 on the TANF case, or
- SIG 7G if the individual was SIG 7 on the TANF case.
- For other household members listed on the case enter
- SIG 0 or 2Y for an adult, or
- SIG 2, 2I, 2IT, 2IU, 2W, or 3 for a child.
Note: The case must be include a SIG 2, 2W, or 3 for the caretaker or second parent to be certified.
Item 127 – Enter Type Program 29.
Item 132 – Enter opening Code 057 on Form H1000-A, Notice of Application, or code 121 on Form H1000-B, Record of Case Action.
Item 136 – Enter the Medicaid end date.
C—625.3 Independent Child as the Case Name When a Representative from a Child Care Facility Applies for the Child
Revision 02-3; Effective April 1, 2002
Medical Programs
Make all minimum entries for the appropriate type program.
Item 13 – Enter the child's residence or, upon request, the address of the child care facility located near the child.
Item 25 – Enter the BJN's county code.
Item 26 – Enter the name of the child care representative as representative payee.
Item 271 – Enter Code R.
Item 40 – Enter SIG Code 8 to designate the child as case name.
Item 164 – Enter the child's residence county code.
C—630 Entries for Actions Taken During the Certification Period
Revision 02-3; Effective April 1, 2002
C—631 Entries for Case Name Changes
Revision 02-3; Effective April 1, 2002
C—631.1 Case Name Changes with Same Household Members
Revision 02-3; Effective April 1, 2002
SNAP
Item 10 – Enter new case name.
Item 40 – Enter # to remove former head of household status.
Item 40 – Enter A for new head of household.
Item 78 – Enter type review.
C—631.2 Case Name Changes When Head of Household Leaves
Revision 02-3; Effective April 1, 2002
SNAP
Item 10 – Enter new case name.
Item 33 – Enter # to remove former head of household.
Item 40 – Enter A for new head of household.
Item 78 – Enter type review.
Item 83 – Enter new household number, if applicable.
C—632 Entries for Households Becoming Eligible for SSI
Revision 02-3; Effective April 1, 2002
C—632.1 TANF Caretaker Becomes Eligible for SSI
Revision 08-4; Effective October 1, 2008
TANF
Item 40 – Enter Code 9.
Item 41 – Enter Code V.
Item 66 – Enter new needs amount.
Item 131 – Enter type review code.
Item 132 – Enter Code 105.
Remove any income entries for the caretaker.
C—632.2 TANF Child Becomes Eligible for SSI
Revision 02-3; Effective April 1, 2002
TANF
Item 40 – Enter Code 3.
Item 41 – Enter Code J.
Item 66 – Enter updated budget entries.
Item 131 – Enter type review.
Item 132 – Enter action code.
Note: SAVERR will not allow a SIG 5 child on the same case a SIG 3 child.
C—633 Entries for Adjusting Certification Periods
Revision 02-3; Effective April 1, 2002
C—633.1 Extending the Certification Period of an Active SNAP Case
Revision 02-3; Effective April 1, 2002
SNAP
Item 78 – Enter Code I.
Item 81 – Enter the new number of months certified.
Item 82 – Enter the new last benefit month.
C—633.2 Shortening the Certification Period of an Active SNAP Case
Revision 02-3; Effective April 1, 2002
SNAP
Item 78 – Enter type review Code I.
Item 81 – Enter the new number corresponding to the original certification date in Item 80 and the new last benefit month in Item 82. Example: If the certification date was 06/01/01, and the new last benefit month is 9/01, enter 04 in this item.
Item 82 – Enter the new last benefit month.
C—634 Miscellaneous Action Entries
Revision 02-3; Effective April 1, 2002
C—634.1 Death of an Active Client
Revision 02-3; Effective April 1, 2002
TANF
Item 40 – Reenter the original status in group codes for the deceased individual plus code X.
Item 47 – Enter the individual's date of death.
Item 131 – Enter the type review code.
Item 132 – If the case is also being denied because of death, enter Code 058 or 059.
C—634.2 Canceling a Previous SNAP Issuance
Revision 02-3; Effective April 1, 2002
SNAP
Item 179 – Enter Code N.
Item 180 – Enter cancellation Code G.
Item 181 – Enter number of the issuance being cancelled.
Item 182 – Enter the issuance date of the benefit being cancelled.
Item 183 – Enter the benefit month of the issuance being cancelled.
Item 185 – Enter the benefit value of the issuance being cancelled.
Item 186 – Enter the recoupment amount (if appropriate).
C—634.3 Households with Disqualified Members
Revision 02-3; Effective April 1, 2002
C—634.3.1 Households with Members Disqualified for Citizenship, or 18-50 Work Requirement, or Noncompliance with SSN Requirements
Revision 02-3; Effective April 1, 2002
SNAP
Make the following entries for the disqualified person:
Item 40 – Enter status in group Code K.
Item 41 – Enter Code T.
Items 42B-45 – Enter prorated income of disqualified person.
Item 60 – Enter appropriate shelter expenses.
Item 83 – Enter number of household members not disqualified.
Item 87 – Enter Code C if household has member disqualified as ineligible alien.
Item 88 – Enter number of household members disqualified as ineligible aliens.
Item 90 – Enter code for prorated shelter expense, if applicable.
Also make corresponding entries onForm H1000-C, Secondary Client Input, in Item 216 to identify the reason for disqualification.
C—634.3.2 Households with Members Disqualified for SNAP Employment Services Noncompliances, Felony Drug Convictions, Refusing to Cooperate with the Quality Control Process, or Being a Fugitive
Revision 08-3; Effective July 1, 2008
SNAP
Make the following entries for the disqualified person:
Item 40 – Enter status in group Code K.
Item 41 – Enter Code T.
Items 42B-45 – Enter total income of disqualified person.
Item 60 – Enter total shelter expenses.
Item 83 – Enter number of household members not disqualified.
Item 90 – Enter appropriate code for shelter expense.
Also make corresponding entries onForm H1000-C, Secondary Client Input, in Item 216 to identify the reason for disqualification.
C—634.4 Reinstating a Person Disqualified for Intentional Program Violation When the Disqualification Expires
Revision 02-3; Effective April 1, 2002
SNAP
Make minimum entries for certification or changes.
Item 40 – Enter the appropriate code.
Item 41 – Enter the appropriate code.
Item 49 – Make no entry.
Item 83 – Enter number of eligible household members including the person who is no longer disqualified.
C—634.5 Reporting Increases in Household Composition with More than 11 Persons
Revision 02-3; Effective April 1, 2002
All Programs
Use more than one set of forms. In addition to the standard entries on the first Input document, complete Item 04, page 1.
Use a Form H1000-A, Notice of Application, packet. Separate the NOA and the Case Index Card from the packet and destroy, leaving the H1000-A Input and case record copy intact. White out the preprinted application number, enter the case number in Item 01, and make the following entries:
Item 03 – Sequence Number
Item 04 – Page
Item 06 – Budgeted Job Number
Item 07 – Mail Code
Item 09 – Case Name
Items 32-50 – Begin with line "b"
Staple the Input document together and batch as one.
C—634.6 Change of Payee or Caretaker
Revision 02-3; Effective April 1, 2002
TANF
Item 10 – Enter new case name.
Items 32-37 – Enter information about case name if the person was not previously included in the case.
Items 40-41 – Enter code for new case name.
Item 46 – Enter medical effective date for new case name if the person is certified as a caretaker and was not previously included in the case.
Item 33 – Enter # to remove previous individual if the individual is to be removed from the case.
Items 40-41 – Enter new codes if the previous case name is to remain in the case.
Item 131 – Enter type review code.
Item 132 – Enter Code 120.
Enter budget and Item 66 entries for situations with these changes.
C—634.7 Three Months Prior Medicaid – No Gap in Coverage on an Active Case
Revision 05-4; Effective August 1, 2005
TANF
Item 46 – Enter new medical effective date.
Item 131 – Enter the type review code.
Item 132 – Enter reinvestigation Code 107 if sustaining or other codes if raising or lowering.
Item 133 – Enter number of months of prior eligibility.
Item 134 – Enter three months prior application date.
To change a medical effective date for more than six months before the current process month, send a memo with supervisor'sapproval to State Office Data Integrity (SODI) Section, Systems Control Division, State Office, Y-922, explaining why the information needs to be processed.
C—634.8 Entering the 90% Earned Income Deduction and Child Care to Ensure Automatic Removal of the Deduction
Revision 05-4; Effective August 1, 2005
TANF
Item 42B – Enter gross earned income.
Item 58 – Enter standard work expense deduction. Do not enter childcare or 90% deduction.
To report child care deduction:
Item 149, line 1 – Enter C.
Item 152, line 1 – Enter total child care deduction.
To report the 90% earned income deduction:
Item 149, line 2 – Enter 9.
Item 151, line 2 – Enter the last month of the four month eligibility period.
Item 152, line 2 – Enter the total allowable 90% earned income deduction.
Item 59 – Enter the remainder of Item 57 minus Items 58 and 152.
SAVERR automatically removes the 90% deduction after cutoff in the month before the month entered in Item 151. If the case is denied, SAVERR transfers assistance to Type Program 37 and adds 12 or 18 months to the month in Item 151.
When processing the automatic removal of the 90% deduction, SAVERR notifies the individual and sends the advisor an updated H1000-Bsequence.
SAVERR will not automatically remove the 90% deduction or transfer the case to TP 37 when a case is on hold. If a Form H1000-B, Record of Case Action, is submitted to remove the hold, remove the 90% deduction by entering
- 9 in Item 149, and
- 0 in Item 152.
If denying the case, process a transfer to TP 37.
C—640 Denial Entries
Revision 02-3; Effective April 1, 2002
C—641 Denial of a TANF/Medical Programs Application
Revision 02-3; Effective April 1, 2002
TANF and Medical Programs
Item 29 – Action Notice
Item 127 – Type Program
Item 132 – Action Code
C—642 Denial of a SNAP Application
Revision 02-3; Effective April 1, 2002
SNAP
To deny an application of Form H1000-A, Notice of Application, make the following entries:
Item 29 – Enter date Form H1017, Notice of Benefit Denial or Reduction, is sent to applicant.
Item 79 – Enter application code.
Item 91 – Enter denial code.
Item 92 – Enter date of denial.
To deny an application on Form H1000-B, Record of Case Action, make these additional entries:
Item 08 – Enter date applied.
Item 78 – Enter C.
C—643 Hold Code 5 Actions Pending Automatic Grant Denial
Revision 02-3; Effective April 1, 2002
TANF
Item 131 – Enter the type review code.
Item 132 – Enter Code 107. Use Code 110 for Type Program 07 cases.
Item 142 – Enter hold Code 5.
Item 143 – Enter denial code.
Do not enter any budgetary changes
If the hold is not released in the hold effective month, an updated sequence Form H1000-B, Record of Case Action, is produced at cutoff of the hold effective month showing the grant denial.
C—644 Denial of an Active Case Because of Failure to Comply with Employment Services
Revision 02-3; Effective April 1, 2002
SNAP
Item 41 – Enter U for the primary wage earner who did not comply.
Item 78 – Enter type review.
Item 91 – Enter Code 610.
Item 92 – Enter last day of month the denial is effective.