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
XXXXXXXXXXXX SHELTER CHANGE FOR NEW ADDRESS XXXXXXXXXXXXXXXXXXXX
DATE SGCC WORKED CASE: 11/3/2006 12:56:03 PM
METHOD OF CONTACT ( )PHONE ( )FAX ( )MAIL ( )OTHER
CONTACT'S NAME/SOURCE:
DOES AU RECEIVE HOUSING ASSISTANCE? YES( ) NO( )
IF YES, WHAT PORTION OF RENT DOES AU PAY:
NEW RENT/MORTGAGE AMOUNT: EFFECTIVE DATE:
HEATING SOURCE: COOLING SOURCE:
WHAT UTILITIES DO YOU PAY:
SUA ALLOWED ( )HC ( ) ACTUAL ( )PHONE ( )NONE
IF( )NONHC; WHY: ( )EXCESS ( )TWO OR MORE UTILITIES
**************ADDRESS MORTGAGE - TAXES/INSURANCE**************
**************SEE MISC REMARKS FOR MANAGEMENT*****************
TYPE OF VERIFICATION:
FORMS SENT ( )C173 ( )C178 ( )C809
SENT DATE:
DUE DATE:
REMARKS:
ENTER NAME, LOAD AND TEL #
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UPDATE REMARKS - REMA REMA
XXXXXXXXXXXXXXXX CHILDSUPPORT DEDUCTION XXXXXXX
DATE SGCC WORKED CASE: 11/3/2006 1:05:27 PM
METHOD OF CONTACT ( )PHONE ( )FAX ( )MAIL ( )OTHER
CONTACT'S NAME/SOURCE:
AU MEMBER PAYING CHILDSUPPORT:
PAYMENT LEGALLY OBLIGATED TO BE PAID TO:
AMOUNT OBLIGATED TO PAY/FREQUENCY:
ACTUAL AMT BEING PAID/FREQUENCY:
TYPE OF VERIFICATION:
******HH MEMBER MUST BE LEGALLY OBLIGATED TO PAY SUPPORT**********
********** SEE MISC REMARKS FOR MANAGEMENT ********************
CALCULATION OF DEDUCTION:
FORM C173 SENT: DUE DATE:
REMARKS:
ENTER NAME, LOAD AND TEL #
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PG-52