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
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXX DEPENDENT CARE XXXXXXXXXXXXXXX
DATE SGCC WORKED CASE: 11/3/2006 1:45:15 PM
METHOD OF CONTACT ( )PHONE ( )FAX ( )MAIL ( )OTHER
CONTACT'S NAME/SOURCE:
PROVIDER'S NAME: PHONE #:
PROVIDER'S ADDRESS:
NAMES OF CHILD[REN] CARED FOR:
AGES OF CHILD[REN]CARED FOR:
AMOUNT YOU PAY FOR EACH CHILD: AMOUNT DFACS PAYS:
FREQUENCY: DAY OF WEEK PAID:
************** SEE MISC REMARKS FOR MANAGEMENT ***************
TYPE OF VERIFICATION:
FORMS SENT( )C173 ( )C178 ( )C809
SENT DATE:
DUE DATE:
REASON FOR CHILDCARE:
REMARKS:
ENTER NAME, LOAD AND TEL #
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UPDATE REMARKS - REMA REMA
XXXXXXXXXXXXXXXXXXXXXXXXXX FSME Medical Deductions XXXXXXXXXXXXXX
Date SGCC Worked Case: 11/3/2006 1:56:33 PM
Method of Contact ( )Phone ( )FAX ( )Mail ( )Other
Contact's Name/Source:
AU Name:
Disabled/Elderly HH member has medical expenses Yes( )No( )
Medicaid Application Pending Yes( )No( )
*If yes,deduction is not allowed since we are unable to verify reimbursement.
Computation or explanation of expenses given, if needed:
Type of Verification:
Forms Sent( )C173 ( )C178 ( )809
Sent Date:
Due Date:
Remarks:
Enter Name, Load and Tel #
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
PG-53