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

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Call <strong>Center</strong> FS/FM SUCCESS PG October 24, 2007 Screening and Registration CIRC for Margaret Simmons Margaret: currently earns $50.00/week at her part-time job and has a final pay check from a terminated position with Reynolds Cleaners in the amount of $125. has no unearned income has $300 in her checking account and $50 cash pays $250/month rent, approximately $50/month for her gas bill and $25 on her phone. REGISTER HOUSEHOLD CIRCUMSTANCES - CIRC CIRC Monthly Income (FS) Earnings Types/Amts EI 200 EI 125 Unearned Types/Amts NI 0 Liquid Resources (FS) Resource Types/Amts CH 300 CA 50 Current Rent/Mortgage/Utilities (FS) 330 Select: Anyone > 18 who formerly recvd SSI Medicare Entitlement Nursing Home Migrant/Seasonal Farmworker MA needed for adult with dep child Any Unpaid Medical Bills Prior Month Community-Based Waiver Hospital Resident Battered Woman Shelter Refugee Authorized Rep Message 0013 0013 REQUIRED FIELDS ARE IDENTIFIED BY "?" 18-tbud PG-15
Call <strong>Center</strong> FS/FM SUCCESS PG October 24, 2007 Screening and Registration MEMB for Margaret Simmons Margaret: was born December 5, 1980 based on her statement is a black female has a Social Security number of 595 01 XXXX (customize the SSN), based on her statement is pregnant; however, do not code pregnancy field REGISTER HOUSEHOLD MEMBER - MEMB MEMB 01 01 Client ID Del F Name MARGARET MI L Name SIMMONS Suf Relationship SE DOB (MM DD YYYY) 12 05 1980 V CS Sex F SSA/SSN Appl For SSN1 595 01 XXXX V CS Race: B W A N P Ethnic: N Preg Due Date Y N N N N Alternate Names F Name MI L Name Suf More Names Additional SSNs SSN V SSN V SSN V SSN V More SSNs Message 0013 0013 REQUIRED FIELDS ARE IDENTIFIED BY "?" 18-tbud More Members 24-del PG-16
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