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

Call Center Food Stamp Phase II PG February 29, 2008
Putting It Together
UPDATE REMARKS - REMA REMA
XXXXXXXXXXXXXX ADDITIONAL HH MEMBERS XXXXXXXXXXXXXXX
DATE SGCC WORKED CASE: 8/15/2007 11:53:23 AM
METHOD OF CONTACT (X )PHONE ( )FAX ( )MAIL ( )OTHER
CONTACT'S NAME/SOURCE: Herman Horton
NEW MEMBER NAME DOB SSN RELATION INCL
: Kelly L. Horton : 02-11-1998 :555-44-XXXX : Niece : Y
: : : : :
: : : : :
SHOULD AU'S BE COMBINED DUE TO AGE/RELATION? Y/N(Y) DATE MOVED IN:
10/02/06 IF NOT INCLUDED, EXPLAIN:
IF INELIGIBLE/SANCTIONED, EXPLAIN:
PREVIOUS WHEREABOUTS ( )INCARCERATED ( )OUT OF STATE ( )FOSTER CARE
IS PERSON A LAWBREAKER (CONVICTED FELON, FLEEING FELON OR PAROLE OR
PROBATION
VIOLATER? YES: NO: N/A WHAT CRIME?:
IF YES, REFER TO POLICY TO SEE IF PERSON CAN BE ADDED TO FS.
REMARKS:
*IMMUNIZATION VERIF. NEEDED FOR 2 MOS. - SCHOOL AGE*SEE DEM FOR
DEPRIVATION*
INCOME OF NEW MEMBER: RSDI RESOURCES OF NEW MEMBER: NONE A/R
WOULD LIKE PERSON ADDED TO FS(X ) TANF( ) MED(X )
TYPE OF VERIFICATION: Received, Faxed on 10/05/06
FORMS SENT( )C173 ( )C178 ( )C809
SENT DATE:
DUE DATE:
REMARKS:
Enter Name, Load and Tel #
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PG-7