Customer Contact Center Food Stamp/Family Medicaid Phase II ...

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Call Center FS & FM Phase II PG February 29, 2008 Initial Application SHEL for Margaret Simmons Refer to Form 354 Expense Statement heats with gas is eligible for the heating/cooling SUA pays $250.00 per month rent; does not have verification with her rents from Mary Hill, 122 Broad Street, Newnan, GA, 30305, (770) 987- 9876 Margaret has paid all her bills for 10/06 INTERVIEW SHELTER EXPENSES - SHEL SHEL 01 Month 11 06 Client Name MARGARET SIMMONS Client ID 777006064 Primary Receive Public SUA Number Phone Heat/Cool LIHEAP Housing/Exc Type V Sharing STD G HC CS Expense Type Amt V Expense Type Amt V Rent 250 ? Mortgage Taxes Insurance Gas Electric Telephone Water Sewer Garbage Disaster Repair Oil Other Fuel Other Housing Landlord Name MARY HILL Phone 770 987 9876 Address 122 BROAD ST City NEWNAN ST GA Zip 30305 Message 0013 0013 REQUIRED FIELDS ARE IDENTIFIED BY "?" 15-lett PG-51
Call Center FS & FM Phase II PG February 29, 2008 Initial Application SHEL Documentation Requirement SHEL REMA • Eligibility for the shelter and utility deductions • Eligibility for the appropriate SUA or telephone standard • Payment of expenses by anyone outside the household and how it is verified • Sharing of expenses and their effect on the deduction and how it is verified • Inclusion of insurance and taxes in the mortgage payment • Computations shelter expenses to a monthly amount • Inclusion of utilities in rent press tilde to document shelter choice UPDATE REMARKS - REMA REMA 01 *********************Shelter / Utility Expense********************** 10/05/2006 14:35; FICM CASEWORKER B123 123Z FULTON 555-555-5555 Does anyone pay part/all of the Shel Exp? Y/N [N] If yes, explain :_____________________________________________________ Housing Cost A/R Incurs Rent[Y] Mortg[ ] Insur[ ] Taxes[ ] Lot Rent[ ] :_______________________________________________________________________ Calc if other than monthly: __________________________________________________ Included in mortg? Insurance[ ] Taxes[ ] If none, explain: ___________ UTILITY EXPENSE incurred by DWELLING? Y/N [Y] Included in Rent? Y/N [N] If none, explain:______________________________________________________ DEWELLING IS ELIGIBLE for Utility Deduction based on; [Y] H/C SUA based on,Heating[G] AC[ ] LIHEAP[ ] Excess H/C Public Hsg[ ] [ ] Non H/C based on two types of expenses:_____________________________ :_______________________OR Excess Non H/C Public Hsg[ ] [ ] Actual based on one type of expense:________________________________ [ ] Eligible for Phone Std only? Is the AU sharing utility expenses? Y/N [N] {Hit tilde for SHEL SHARED} :_______________________________________________________________________ MESSAGE More 13-bott PG-52
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