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

Call Center FS/FM SUCCESS PG October 24, 2007
Documentation MACROS/Quick Scripts
UPDATE REMARKS - REMA REMA
XXXXXXXXXXXXXXXX ADDITIONAL HH MEMBERS XXXXXXXXXXXXXXXXXXXXXXXX
DATE SGCC WORKED CASE: 11/3/2006 12:39:54 PM
METHOD OF CONTACT ( )PHONE ( )FAX ( )MAIL ( )OTHER
CONTACT'S NAME/SOURCE:
NEW MEMBER NAME DOB SSN RELATION INCL
: : : : :
: : : : :
: : : : :
: : : : :
SHOULD AU'S BE COMBINED DUE TO AGE/RELATION? Y/N( ) DATE MOVED IN:
PREVIOUS WHEREABOUTS ( ) INCARCERATED ( ) OUT OF STATE ( ) FOSTER CARE
( ) OTHER PARENT ( ) OTHER EXPLAIN:
IF OUT OF STATE, DID AU MEMBER RECEIVE BENEFITS IN LAST STATE? Y/N ( )
IF NOT INCLUDED, EXPLAIN:
IF INELIGIBLE/SANCTIONED, EXPLAIN:
*IMMUNIZATION VERIF. NEEDED FOR 2 MOS. - SCHOOL AGE*SEE DEM FOR DEPRIVATION*
INCOME OF NEW MEMBER: RESOURCES OF NEW MEMBER:
A/R WOULD LIKE PERSON ADDED TO FS( ) TANF( ) MED( )
TYPE OF VERIFICATION:
FORMS SENT( )C173 ( )C178 ( )C809
SENT DATE: DUE DATE:
REMARKS:
ENTER NAME, LOAD AND TEL #
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PM-13