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
XXXXXXXXXXXXXX CHANGE IN DEPENDENT CARE XXXXXXXXXXXXXXXXXXXXXXXXX
DATE SGCC WORKED CASE: 11/3/2006 12:47:30 PM
METHOD OF CONTACT ( )PHONE ( )FAX ( )MAIL ( )OTHER
CONTACT'S NAME/SOURCE:
CHANGE IN: AMOUNT ( ) PROVIDER ( ) BOTH ( )
*******PREVIOUS PROVIDER'S NAME: PHONE #:
NAMES OF CHILD[REN] CARED FOR:
AMOUNT PAID TO PROVIDER:
LAST DAY AT OLD PROVIDER OR AT OLD AMOUNT:
REASON FOR CHANGE:
*******NEW PROVIDER'S NAME: PHONE #:
PROVIDER'S ADDRESS:
NAMES AND AGES OF CHILD[REN] CARED FOR:
AMOUNT YOU PAY FOR EACH CHILD: AMOUNT DFACS PAYS:
FREQUENCY: DAY OF WEEK PAID:
TYPE OF VERIFICATION:
FORMS SENT( )C173 ( )C178 ( )C809 DUE DATE:
REASON FOR CHILDCARE:
REMARKS:
ENTER NAME, LOAD AND TEL #
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PM-14