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

Call Center Food Stamp Phase 2 PG October 24, 2007
Financial Changes
UPDATE REMARKS - REMA REMA
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX LOSS OF WAGES XXXXXXXXXXXXXXXXXXX
DATE SGCC WORKED CASE: 11/3/2006 1:53:27 PM
METHOD OF CONTACT ( )PHONE ( )FAX ( )MAIL ( )OTHER
CONTACT'S NAME/SOURCE:
PERSON NO LONGER WORKING:
LAST DAY OF WORK: DATE AND AMOUNT OF FINAL CHECK:
CHILDCARE DELETED: REASON NO LONGER WORKING:
WAS COUNTY NOTIFIED OF VOLUNTARY QUIT:
EMPLOYER'S NAME: EMPLOYER'S PHONE #:
SUPERVISOR'S NAME:
HAS A/R APPLIED FOR UCB OR ANY OTHER ASSISTANCE:
*****UPDATE WORK CODE IF NECESSARY*** SEE MISC REMARKS FOR MANAGEMENT ***
TYPE OF VERIFICATION:
FORMS SENT( )C173 ( )C178 ( )C809
SENT DATE:
DUE DATE:
REMARKS:
ENTER NAME, LOAD AND TEL #
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
UPDATE REMARKS - REMA REMA
XXXXXXXXXXXXXXXXXXXXXXXXXXXXX REPORT OF NEW JOB XXXXXXXXXXXX
DATE SGCC WORKED CASE: 11/3/2006 2:01:11 PM
METHOD OF CONTACT ( )PHONE ( )FAX ( )MAIL ( )OTHER
CONTACT'S NAME/SOURCE:
PERSON WORKING:
EMPLOYER NAME:
EMPLOYER ADDRESS:
EMPLOYER'S PHONE NUMBER:
START DATE:
HOURS WORKED PER WEEK:
RATE OF PAY:
FREQUENCY OF PAY: DAY OF WEEK PAID:
DATE FIRST CHECK RECEIVED:
DOES A/R HAVE INSURANCE: DOES A/R PAY CHILDCARE:
CALCULATION OF PAY:
DOES A/R RECEIVE UCB/WORKERS COMP/CONTRIBUTION:
********** UPDATE WORK CODE IF NECESSARY **********
TYPE OF VERIFICATION:
FORMS SENT( )C173 ( )C178 ( )C809
SENT DATE:
DUE DATE:
REMARKS:
ENTER NAME, LOAD AND TEL #
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
PG-4